Harbor:Forms
Printable FORMS
Work Notes
- Work Excuse http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Work%20Excuse.pdf
- Family Work Excuse http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Family%20Work%20Excuse.pdf
Clinics
- CHC Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/CHC.pdf
- Dental Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Dental%20Clinics.pdf
- Women's (Gyn) Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Womens%20Clinics.pdf
- Pediatric Same-Day Clinic http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Pediatric%20Same%20Day%20Clinic%20at%20Harbor.pdf
- Adult Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Psych%20Referrals.pdf
- Pediatric Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Peds%20Psych%20Referrals.pdf
- Shelter Resources for the Homeless http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Shelter%20Resources.pdf
- Substance Abuse Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Substance%20Abuse%20Referral.pdf
Clinical Forms
- Heparin Infusion http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Heparin%20Infusion%20Adult.pdf
- Peripheral Pressor Extravasation (pages 5-6) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Extravasation%20Management.pdf
- Pathology Tissue Report http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Path%20Form.pdf
- Pediatric Tylenol/Motrin Dosing http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Tylenol%20Motrin%20Peds%20Dosing.pdf
Legal Forms
- General Consent (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-English.pdf
- General Consent (Spanish)http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-Spanish.pdf
- Telegram http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Telegram.pdf
- DMV Form http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/DMV%20LOC%20Form.pdf
- OK to Book http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/OK%20to%20Book.pdf
- AMA (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20English.pdf
- AMA (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20Spanish.pdf
- PHI Release http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/PHI%20Release.pdf
- Imaging Request http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Imaging%20Request%20Form.pdf
- Photo Consent http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Photo%20Consent.pdf
- POLST (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-English.pdf
- POLST (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-Spanish.pdf
- Dog Bite Reporting (PDF | Online Form)
Resident Procedures Direct Observation Forms
- Central Line http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Central%20Line.pdf
- Chest Tube http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Chest%20Tube.pdf
- I&D http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20I+D.pdf
- Intubation http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Intubation.pdf
- Laceration Repair http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Lac%20Repair.pdf
- Lumbar Puncture http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20LP.pdf