Outreach Forms

Required forms for outreach (at NCFHP contract sites):

• 2019 Adult Health Assessment_Base Questions
• 2019 Adolescent Health Assessment_Base Questions
• 2019 English Adolescent Health Assessment_Base Questions
• 2019 Pediatric Health Assessment_Base Questions
• Behavioral Health Screening Tool (RHS-15)
• Acute Illness Reporting Form and Protocol (AIR)

Additional recommended forms:

• optional questions ADULT
• optional questions ADOLESCENT
• optional questions PEDIATRIC
• 2019 Enabling Encounter Form
• 2019 Medical Encounter Form
• Site Register
• Migrant Clinicians Network (MCN) Enrollment Form English
• Migrant Clinicians Network (MCN) Enrollment Form Spanish