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| Form ID: | CH-1205 |
| Description: | Nurse's Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White/Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | CM-1001 |
| Description: | Intake & Output Evaluation (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | CM-1005A |
| Description: | Resident Care Plan (Index) - Pg.1 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | CM-1005B |
| Description: | Resident Care Plan (Index) - Pg.2 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | CM-1007 |
| Description: | Decubitus Summary |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | CM-1012 |
| Description: | Licensed Nurses Progress Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White/Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | EH-1580 |
| Description: | 24 Hr. Resident Condition Report Book - 8 hr Shifts |
| Size: | 11 x 17 |
| Paper: | 4 part NCR |
| Color: | W-Y-P-Gold |
| Sides: | 1 |
| Unit: | Book/50 |
| Form ID: | EH-2033 |
| Description: | Initial Nursing History & Assmnt (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | HMI-4014 |
| Description: | Private Census Report |
| Size: | 8-1/2 x 14 |
| Paper: | 20# Bond |
| Color: | Blue |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | HMI-4015 |
| Description: | Medi-Caid Census Report |
| Size: | 8-1/2 x 14 |
| Paper: | 20# Bond |
| Color: | Yellow |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | HMI-4016 |
| Description: | Medicare Census Report |
| Size: | 8-1/2 x 14 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | JWA-115 |
| Description: | Personal Inventory Update |
| Size: | 3-1/4 x 7 |
| Paper: | 2 part NCR |
| Color: | Green/White |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | JWA-117A |
| Description: | Resident Care Plan - Pg. 1 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | JWA-117B |
| Description: | Resident Care Plan - Pg. 2 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | JWA-117BB |
| Description: | Resident Care Plan - Short Term Problems (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | Blue |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | JWA-166ADL |
| Description: | Care Plan Alert w/ ADL |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | Peach |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | KS-5348 |
| Description: | Nurses' Admission Record |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Orchid |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | NU-1425 |
| Description: | Nursing History/Assment/ Adm. Record |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | NU-1430 |
| Description: | Podiatry Progress Notes |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Blue |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | NU-1614 |
| Description: | Weekly Summary |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNF-53 |
| Description: | Resident Admission and Assessment Form |
| Size: | 8.5 X 11 |
| Paper: | 20# Bond |
| Color: | Goldenrod |
| Sides: | 4 |
| Unit: | 100 |
| Form ID: | RNf-55A |
| Description: | Resident Care Plan (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-55E |
| Description: | Resident Care Plan - Addendum (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-55F |
| Description: | Resident Care Plan - Episodic (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 90# Index |
| Color: | Green |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-58 |
| Description: | Physician's Enteral Orders |
| Size: | 8-1/2 x 11 |
| Paper: | 4 part NCR |
| Color: | W-Y-P-Gold |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | RNf-60 |
| Description: | Physicians Admission Orders |
| Size: | 8-1/2 x 11 |
| Paper: | 3 part NCR |
| Color: | W-Y-P |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | RNf-64 |
| Description: | Intake/Output Record |
| Size: | 4-1/4 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | RNf-65DA |
| Description: | Nurse Assistant Flowsheet - AM Shift (Black Ink) |
| Size: | 11 x 8-1/2 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-65N |
| Description: | Nurse Assistant Flowsheet - Night Shift (Red Ink) |
| Size: | 11 x 8-1/2 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-65PM |
| Description: | Nurse Assistant Flowsheet - PM Shift (Green Ink) |
| Size: | 11 x 8-1/2 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-66 |
| Description: | Intake and Output Record (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-67 |
| Description: | Licensed Nurses Progress Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-69 |
| Description: | Physician Progress Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Green |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-70 |
| Description: | Interdisciplinary Progress Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Yellow |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-74 |
| Description: | Weekly Pressure Sore Report |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-74A |
| Description: | Non-Pressure Sore Skin Problem Report |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Yellow |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | RNf-75 |
| Description: | Resident Inventory of Personal Effects |
| Size: | 8-1/2 x 11 |
| Paper: | 3 part NCR |
| Color: | W-Y-P |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | RNf-90 |
| Description: | Resident Joint Mobility Assessment |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SBHC-12994 |
| Description: | Shower Day report |
| Size: | 6 x 2-1/2 |
| Paper: | 3 part NCR |
| Color: | W-Y-P |
| Sides: | 1 |
| Unit: | Book/50 |
| Form ID: | SD-125 |
| Description: | Joint Mobility Assessment |
| Size: | 11 x 17 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | S/50 |
| Form ID: | SJ - 4741 |
| Description: | Nurse Assistant Record 1-16 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SJ - 4741A |
| Description: | Nurse Assistant Record 17-31 (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-0788 |
| Description: | Nursing Assessment and Evaluation |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-1007 |
| Description: | Resident Transfer & Referral Record |
| Size: | 11 x 8-1/2 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | SNF-1008 |
| Description: | Multidisciplinary Report (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-1011 |
| Description: | Inventory of Personal Effects |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | SNF-1037 |
| Description: | Laxative & B.M. Record |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-1062 |
| Description: | Resident's Clothing & Possessions |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | SNF-1069 |
| Description: | Nursing Care Kardex |
| Size: | 8 x 5 |
| Paper: | 90# Index |
| Color: | White |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-2002 |
| Description: | Daily Log |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-2004 |
| Description: | Licensed Nurses Progress Notes (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-2005 |
| Description: | Floor Narcotic Release |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-2006 |
| Description: | Monthly Record of Vital Signs & Weights (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-2012 |
| Description: | Narcotic and Hypnotic Record |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-2014 |
| Description: | Nurses Admission Record |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-2015 |
| Description: | Vital Signs & Weights |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-24 |
| Description: | 24 Hour Nursing Report |
| Size: | 8-1/2 x 14 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | SNF-4002 |
| Description: | Telephone Orders - Mount Sheet |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Blue |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-4003 |
| Description: | Employee Orientation Checklist |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Blue |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-527 |
| Description: | Licensed Nurse Weekly Summary (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Pink |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-6001A |
| Description: | Physician's Progress Notes Addendum (HF or HH) |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Yellow |
| Sides: | 2 |
| Unit: | P/100 |
| Form ID: | SNF-6010 |
| Description: | History and Physical |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | Yellow |
| Sides: | 1 |
| Unit: | P/100 |
| Form ID: | SNF-8007 |
| Description: | 24 Hr. Resident Condition Report Book -12 hr Shifts |
| Size: | 12-1/4 x 11 |
| Paper: | 3 part NCR |
| Color: | W-Y-P |
| Sides: | 1 |
| Unit: | Book |
| Form ID: | SNF-8013A |
| Description: | Advance Directive Decisions |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | W/Yellow |
| Sides: | 2 |
| Unit: | Set 100 |
| Form ID: | SNF-8013B |
| Description: | Advance Directive Signature Sheet |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | W/Yellow |
| Sides: | 2 |
| Unit: | Set 100 |
| Form ID: | SNF-8030 |
| Description: | Nurse Dialysis Communication Record |
| Size: | 8-1/2 x 11 |
| Paper: | 2 part NCR |
| Color: | White/Yellow |
| Sides: | 1 |
| Unit: | S/50 |
| Form ID: | SNF-9005 |
| Description: | Physician's Telephone Orders |
| Size: | 3 - 1/4 x 7 |
| Paper: | 3 part NCR |
| Color: | W-Y-P |
| Sides: | 1 |
| Unit: | S/200 |
| Form ID: | SNF-9006 |
| Description: | Physician's Telephone Orders - 3 per page |
| Size: | 8-1/2 x 11 |
| Paper: | 4 part NCR |
| Color: | W-Y-P-Gold |
| Sides: | 1 |
| Unit: | S/100 |
| Form ID: | SNF-9016 |
| Description: | Pain Assessment Flowsheet |
| Size: | 8-1/2 x 11 |
| Paper: | 20# Bond |
| Color: | White |
| Sides: | 2 |
| Unit: | P/100 |
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