Home Page

UTHCPC Procedures - Volume 4 Index

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

- A -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Access to Open Record Request form 1

Addendum forms

Child and Adolescent 1

Administrative Alert form 1

Administrative Request for Court-Ordered Services form 1

Admitting Orders, Physician's, form 1

Admitting Provisional Diagnosis form 1

Advance Directives Notification form 1

Adverse Drug Reaction Report, Possible, form 1

Alert, Administrative, form 1

Application for Modification - Inpatient to Outpatient/Change of Programs form 1

Application-Emergency Detention-Sec 28(a) form 1

Approved Abbreviations and Symbols for Charting 1

Assessment forms

Child and Adolescent Addendum form 1

Initial Nursing Assessment 1

Interdisciplinary Patient Assessment form 1

Authorization to Disclose Patient Information form 1

Authorization to Release Medical Record Information form 1

Authorization to Release Medical Record Information form in Spanish 1

- B -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

BIPE 1

Bomb Threat Report form 1

Bona fide job offer letter 1

Brain Imaging Request form 1

Brief Initial Psychiatric Examination form 1

Budget Proposal Form 1

Business Continuity Plan 1

- C -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Certificate of Least Restrictive Alternative form 1

Certificate of Medical Examination form

With OPC - Chemical Dependency - Sec. 3.03 1

Modification to Inpatient (Section 53) 1

Modification to Outpatient (Section 53) 1

With OPC - Extended (Section 33) 1

With OPC - Temporary (Section 33) 1

Certificate of Return-Application and Affidavit to Magistrate 1

Certificate of Return-To Any Health or Peace Officer in the State of Texas 1

Change of Programs, Inpatient to Outpatient, Application for Modification form 1

Charge Description Master Update 1

Chemical Dependency, with OPC Sec. 3.03, Certificate of Medical Exam form 1

Child and Adolescent Addendum 1

Clinical Services Emergency Management Plan 1

Code Blue Evaluation 1

Code Blue/Medical Emergency Documentation Record 1

Code of Ethics 1

Confidentiality Cover Sheet form 1

Consent for Treatment Influenza and/or Pneumonia Shots 1

Consent to Treatment with Psychoactive Medication form 1

Consult for religiosity 1

Consultation and Consultation Summary, Request for, form 1

Consultation request, seclusion/restraint 1

Continuum Referral Disposition Report 1

Contract services, guidelines 1

Cost Reduction Suggestion form 1

Court-Ordered Inpatient Mental Health Services, Termination of, form 1

Court-Ordered Services, Administrative Request for, form 1

- D -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Daily Central Log 1

Data Processing Service Request 1

Detention for Modification, Request for Temporary (Section 53), form 1, 2

Dismissal of Modification, Request for, form 1

Dismissal of Order of Protective Custody, Request for, form 1

Doctor's Mental Status Examination for Guardianship 1

Drug Reaction Report, Possible Adverse, form 1

- E -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Education, Job-Related Training and

Employee Request Form 1

Emergency Preparedness & Staffing in Emergency Conditions Employee Acknowledgement 1

Employee Checkout form 1

Employee Request Form, Job-Related Training and Education 1

EMTALA Flowchart 1

Exclusion Criteria Checklist form 1

- F -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Fall Variance Report 1

Fax Cover Sheet 1

Fire Drill Group Check Sheet 1

Formulary 1

- G -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Guardianship, Doctor's Mental Status Examination for 1

Guidelines for contract services 1

- H -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Hazardous Material Spill Report form 1

History and physical exam 1

HIV Test Request and Consent form 1

- I -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

ID Badge Replacement Authorization Form 1

Informed Consent Checklist form 1

Initial Nursing Assessment form 1

Initial Psychiatric Examination form 1

Inpatient to Outpatient/Change of Programs, Application for Modification form 1

Inpatient and Outpatient Healthcare Billing Compliance Plan 1

Insurance Master Update form 1

Interdisciplinary Patient Assessment 1

Interpreter Peer Observation form 1

- J -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Job-Related Training and Education

Employee Request Form 1

- L -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Language Competency Pay Application 1

Language Interpreter and Translator Code of Professional Conduct 1

Least Restrictive Alternative Form 1

Lesson Plan Cover Sheet form 1

Letter of Retraction form 1

Letter of Understanding Precinct One 1

- M -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Magistrate's Order for Emergency Apprehension and Detention-Sec 28(e) form 1

Master Treatment Plan Cover Sheet form 1

Master Treatment Plan Review form 1

Medical Examination form, Certificate of

Modification to Inpatient (Section 53) 1

Modification to Outpatient (Section 53) 1

With OPC - Extended (Section 33) 1

With OPC - Temporary (Section 33) 1

Medical Record Amendment Request form 1

Medication Usage Evaluation (MUE) Criteria Checklist 1

Memorandum of Transfer form 1

Minimum Training Reference Guide 1

Minimum Training Reference Guide and Competency Curriculum 1

Missing or Stolen Property Report form 1

Modification to Inpatient (Section 53), Certificate of Medical Examination form 1

Modification to Outpatient (Section 53), Certificate of Medical Examination form 1

Modification, Request for Dismissal of, form 1

Move Request 1

MPA, Integrated Summary, and MTP form 1

- N -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Now Order for Involuntary Emergency Administration of Psychoactive Medication 1

- O -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Occurrence Report form 1

OPC - Extended (Section 33), Certificate of Medical Examination form 1

OPC - Temporary (Section 33), Certificate of Medical Examination form 1

OPC Sec. 3.03 - Chemical Dependency, Certificate of Medical Exam form 1

Order of Protective Custody, Request for Dismissal of, form 1

- P -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

PA form 1

Pain Management Guidelines/Modalities 1

Pastoral care consult 1

Patient Care Variance Report form 1

Patient Leaving Against Medical Advice, Statement of, form 1

Patient Relations Consultation (Patient/Family) form 1

Patient Relations Consultation (Staff) form 1

Patient Rights Signature Form 1

Patient Transfer to a State Facility, Request for, 1

Patient/Family Education Sheet form 1

Personnel Action form 1

Petition for outpatient commitment 1

Physician's Admitting Orders form 1

Physician's Orders for Ancillary Services 1

Physician's Orders for Seclusion/Restraint form 1

Physician's Orders form 1

Policy and Procedure Approval, Signature Sheet form 1

Policy and Procedure Checklist form 1

Possible Adverse Drug Reaction Report form 1

Post Discharge Plan 1

Preliminary Medical-Section 27(a) form 1

Pre-Screening form 1

Progress note form, teachers (for adolescent) 1

Progress note form, teachers (for children) 1

Progress Notes form 1

Protective Custody, Request for Dismissal of Order of, form 1

Psychiatric Examination, Initial, form 1

Psychoactive Medication, Consent to Treatment with, form 1

- R -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Refrigerator Temperature Log form 1

Release, Request for, form 1

Report of Transfer of Equipment form 1

Request for Change to a Revenue/Cost Center form 1

Request for Consultation and Consultation Summary form 1

Request for Dismissal of Modification form 1

Request for Dismissal of Order of Protective Custody form 1

Request for Patient Transfer to a State Facility form 1

Request for Release form 1

Request for Temporary Detention for Modification (Section 53) form 1

Research 1

Research Budget Proposal

Additional Years form 1

First Year form 1

Research Information Request Routing Sheet form 1

Research Information Request Routing Sheet form, HCPC 1

Restraint checklist 1

Retraction, Letter of, form 1

Revenue/Cost Center, Request for Change to, form 1

Root cause analysis 1

- S -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Seclusion/restraint Consultation Request form 1

Section 3.03 - Certificate of Medical Exam, With OPC - Chemical Dependency form 1

Section 33 - With OPC - Extended, Certificate of Medical Examination form 1

Section 33 - With OPC - Temporary, Certificate of Medical Examination form 1

Section 53 - Modification to Inpatient, Certificate of Medical Examination form 1

Section 53 - Modification to Outpatient, Certificate of Medical Examination form 1

Section 53 - Request for Temporary Detention for Modification form 1

Sentinel or High Risk Events and Root Cause Analysis 1

Signature Sheet for Policy and Procedure Approval form 1

Small Pox Exposure Control Plan 1

Space Request Form 1

Staff Rights Special Request Form 1

Statement of Patient Leaving Against Medical Advice form 1

Storage Request Form, Warehouse 1

Supervisors First Report of Injury 1

Symbols, used for charting 1

- T -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Teacher's Progress Note - Adolescent form 1

Teacher's Progress Note - Child form 1

Teacher's Weekly Progress/Feedback for Subacute Adolescent Services 1

Temporary Detention for Modification. Request for (Section 53), form 1

Temporary Removal of Equipment form 1

Termination of Court-Ordered Inpatient Mental Health Services form 1

Time and Attendance Request Form 1

Transfer Clearance Form 1

Transfer of Equipment, Report of, form 1

Transfer to a State Facility, Request for Patient, form 1

Transfer, Memorandum of, form 1

Translation Services Survey form (English) 1

Translation Services Survey form (Spanish) 1

Tuberculin Skin Test Evaluation Form 1

- U -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Unacceptable Abbreviations 1

- V -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Variance Report, Patient Care, form 1

- W -

A | B | C | D | E | F | G | H | I | J | L | M | N | O | P | R | S | T | U | V | W

Warrant application form, A18 Warrant-Emergency Apprehension and Detention-Sec 28(e) 1

Warrant application form, A19 Magistrate's Order for Emergency Apprehension and Detention-Sec 28(e) 1

Warrant application form, A20 Application-Emergency Detention-Sec 28(a) 1

Warrant application form, F11 Preliminary Medical-Section 27(a) 1

Warrant-Emergency Apprehension and Detention-Sec 28(e) form 1