Harbor:Forms

Printable FORMS

• Work Notes

1. Work Excuse http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Work%20Excuse.pdf
2. Family Work Excuse http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Family%20Work%20Excuse.pdf

• Clinics

1. CHC Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/CHC.pdf
2. Dental Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Dental%20Clinics.pdf
3. Women's (Gyn) Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Womens%20Clinics.pdf
4. Pediatric Same-Day Clinic http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Pediatric%20Same%20Day%20Clinic%20at%20Harbor.pdf
5. Adult Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Psych%20Referrals.pdf
6. Pediatric Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Peds%20Psych%20Referrals.pdf
7. Shelter Resources for the Homeless http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Shelter%20Resources.pdf
8. Substance Abuse Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Substance%20Abuse%20Referral.pdf

• Clinical Forms

1. Heparin Infusion http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Heparin%20Infusion%20Adult.pdf
2. Peripheral Pressor Extravasation (pages 5-6) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Extravasation%20Management.pdf
3. Pathology Tissue Report http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Path%20Form.pdf
4. Pediatric Tylenol/Motrin Dosing http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Tylenol%20Motrin%20Peds%20Dosing.pdf

• Legal Forms

1. General Consent (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-English.pdf
2. General Consent (Spanish)http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-Spanish.pdf
3. Telegram http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Telegram.pdf
4. DMV Form http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/DMV%20LOC%20Form.pdf
5. OK to Book http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/OK%20to%20Book.pdf
6. AMA (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20English.pdf
7. AMA (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20Spanish.pdf
8. PHI Release http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/PHI%20Release.pdf
9. Imaging Request http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Imaging%20Request%20Form.pdf
10. Photo Consent http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Photo%20Consent.pdf
11. POLST (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-English.pdf
12. POLST (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-Spanish.pdf
13. Dog Bite Reporting (PDF | Online Form)

• Resident Procedures Direct Observation Forms

1. Central Line http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Central%20Line.pdf
2. Chest Tube http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Chest%20Tube.pdf
3. I&D http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20I+D.pdf
4. Intubation http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Intubation.pdf
5. Laceration Repair http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Lac%20Repair.pdf
6. Lumbar Puncture http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20LP.pdf