Forms

Physician and Facility Contact List - A list of physicians and contact information to cross reference for each facility.

Anti-Coagulation Flow Sheet - A two sided worksheet designed to support ECP, PA's recommended Anticoagulation Policy.

Medical Director's Meeting Log - A form designed to help practicing Nursing Facility Medical Directors document their activities. The listed activities are stated in language that corresponds to the job duties outlined by AMDA and CMS.

Dictation Guide for Nursing - A collaborative form for use by a Facility's nursing staff and the rounding physician. It is designed to communicate pertinent patient information, and nursing observations to the Physician. The Physician uses the form to note his/her observations, findings, and plans, so they are in order for subsequent dictation/transcription.

Physical Exam Form - A template and worksheet for use with comprehensivve patient assessments which follows the sequence of ECP's electronic medical record (EMR).

NC MOST Form - MOST is an acronym for 'Medical Orders for Scope of Treatment'. This form can replace our less comprehensive State approved DNR form as the primary document to guide clinicians when treating seriously ill patients. ECP encourages Nursing Facilities to learn how to use this form and adopt it in their procedures for documenting End of Life choices for patients. This will increase the likelihood that an On-Call Physician will render treatment consistent with patient/family desires. To order the forms follow this link: http://www.ncdhhs.gov/dhsr/EMS/pdf/mostorderform2.pdf