Tools for Providers   Documentation Guidelines & Sample Forms   Medical Home Publications

Practices, Policies and Procedures Appendices
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• The Medical Home Index
  
  
• The Medical Home Family Index
  
  
• Incorporating Quality Improvement Into Pediatric Practice Management
  
  
• Exeter Pediatric: Office Visit Family “Mini” Survey (Pre-Visit)
  
  
• Exeter Pediatric: Family Survey (Post-Visit)
  
  
• Exeter Pediatrics: Provider Survey
  
  
• Practice Procedures Fact Sheet
  
  
• Hitchcock Clinic—Concord Pediatric: Care Plan (Parts I and II)
  
  
• Release Form—Request for Non-CHMC Medical Records
  
  
• Release Form—Authorization for Use and/or Disclosure of Protected Health Information to Schools
  
  
• Referral Fax Back Form
  
  
• Long Term Care Form
  
  
• Child History Fact Sheet
  
  
• Evaluating Managed Care Plans for Children With Special Health Needs: A Purchaser’s Tool
  
  
• Special Requirements for Electronic Medical Record Systems in Pediatrics
  
  
• Medical Home Crosswalk to Reimbursement
  
  
• Emergency Preparedness for Children With Special Health Care Needs
  
  
• CHMC ED Referral Fax Form
  
  
• Additional Resources