Outreach Forms

Required forms for outreach (at NCFHP contract sites):

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

Additional recommended forms:

• Enabling Encounter Form
• Medical Encounter Form
• Site Register
• Migrant Clinicians Network (MCN) Enrollment Form English
• Migrant Clinicians Network (MCN) Enrollment Form Spanish