

<!-- index.cfm -->


<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">

<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<meta name="Description" content="IHS National Council of Chief Clinical Consultants - NC4">
<meta name="keywords" content="chief clinical consultants,ihs,indian health service,dental,addiction medicine,pain care,advanced nurse practitioner,anesthesiology,family practice,internal medicine,nephrology,obstetrics,gynecology,obgyn,ophthalmology,optometry,pediatrics,physical rehab,physician assistants,podiatry,surgery">


	<link rel="P3Pv1" href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/w3c/p3p.xml">


<link href="nc4Styles.css" rel="stylesheet" type="text/css">

<title>NC4 - Clinical Forms: Organ System</title>

</head>


<script type="text/javascript">
  var pageurl = window.location.href.toString();
  if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/wmd\/.*/i)){
    var wmNotice = "This web site was frozen on January 31, 2009.  It is now a Federal record managed on behalf of the National Archives and Records Administration.  External links were active as of that date and time. This website is best viewed with Internet Explorer v6 and above; some functionality may not be present in other browsers.  For additional technical issues, <a href=\"https://www.library.unt.edu/forms/govdocs/contact-us-cybercemetery/\">contact us</a>. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012";
  }
  else if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/fcic\/.*/i)){
    var wmNotice = "This website was frozen on March 10, 2011 and is a federal record managed on behalf of the National Archives and Records Administration. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012</p>&nbsp;&nbsp;<p><span style=\"font-weight:bold; font-size: 12pt\">To visit the live, searchable FCIC website hosted by Stanford University&#39;s Rock Center for Corporate Governance and Stanford Law School <a href=\"http://fcic.law.stanford.edu\">click here</a> or  visit <a href=\"http://fcic.law.stanford.edu\">http://fcic.law.stanford.edu</a></span>.";
  }
  else if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/expectmore\/.*/i)){
    var wmNotice = "<b>Expect More.gov</b> was an initiative of the George W. Bush administration. This website has been archived and is posted here as an historical resource.  It has not been updated since the end of 2008 and links to many external websites and some internal pages will not work. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012";
  }
  else if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/cecanf\/.*/i)){
    var wmNotice = "<br /><br />External links, forms, and search boxes may not function within this collection. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012<br />To access past events from the Events portion of this site, right click on the <b>Previous Events</b> link, copy the link location, and paste that into your browser address bar directly.";
  }
  else if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/brc\/.*/i)){
    var wmNotice = "External links, forms, and search boxes may not function within this collection. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012<br /><b>For more current information please go to</b> <a href=\"http://www.nuclear.energy.gov/newsroom/BRC_info.html\">http://www.nuclear.energy.gov/newsroom/BRC_info.html</a>";
  }
  else if(pageurl.match(/https?:\/\/(www\.)?cybercemetery\.unt\.edu\/archive\/womensvote100\/.*/i)){
    var wmNotice = "External links, forms, and search boxes may not function within this collection. Url: 9/21/12 1:54 PM  Archived: 18:54:43 Sep 21, 2012<br />Follow the WSCC on <a href=\"https://twitter.com/WomensVote100\">Twitter</a> at <a href=\"https://twitter.com/WomensVote100\">https://twitter.com/WomensVote100</a>";
  }
  else{
    var wmNotice = "External links, forms, and search boxes may not function within this collection. Url: http://www.ihs.gov/NonMedicalPrograms/NC4/index.cfm?module=formsOrgSys  Archived: 18:54:43 Sep 21, 2012";
  }
  var wmHideNotice = "hide";
  var contextRoot = "https://cybercemetery.unt.edu/archive/oilspill/";
</script>
<script type="text/javascript" src="https://cybercemetery.unt.edu/archive/oilspill/js/disclaim.js"></script>

<body onLoad="stripe('formsColor', '#fff', '#f1f1f1');">
<a name="top"></a>


<!--[if lte IE 6.5]>
<style type="text/css">
#CORE_outerShell3, #CORE_bottomGradient { background: none!important; }
</style>
<![endif]-->


<link href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443cs_/http://www.ihs.gov/GeneralWeb/WebComponents/StyleSheets/redesign08/ihsTemplateBodyBGcolor.css" rel="stylesheet" />


	<div id="CORE_outerShell">
		<div id="CORE_outerShell1">
			<div id="CORE_outerShell2">
              <div id="CORE_outerShell3">
				<div id="CORE_headerBorder">
                <div id="CORE_header">

					<a name="skipIHSfooter" href="#skipIHSheader" title="Skip IHS header, go to content"></a> 
					
	<script type="text/javascript">
		var gaJsHost = (("https:" == document.location.protocol) ? "https://cybercemetery.unt.edu/archive/oilspill/20120921185443/https://ssl." : "http://www.");
		document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E"));
	</script>
	<script type="text/javascript">
		try {
			var pageTracker = _gat._getTracker("UA-5124034-1");
			pageTracker._trackPageview();
		} catch(err) {}
    </script>


<link rel="shortcut icon" href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443im_/http://www.ihs.gov/images/IHSicon.ico" type="image/x-icon">
<link rel=stylesheet href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443cs_/http://www.ihs.gov/GeneralWeb/WebComponents/StyleSheets/SectionPages.css" type="text/css">
<!--<link rel=stylesheet href="/GeneralWeb/WebComponents/basic.css" type="text/css">-->
<link href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443cs_/http://www.ihs.gov/GeneralWeb/WebComponents/StyleSheets/redesign08/SectionPages.css" rel="stylesheet" type="text/css" media="screen">
<!--<link href="/GeneralWeb/WebComponents/StyleSsheets/redesign08/SectionPagesPrint.css" rel="stylesheet" type="text/css" media="print">-->


	<link rel="P3Pv1" href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/w3c/p3p.xml">


<!--[if lte IE 7]>
<style type="text/css">
</style>
<![endif]-->


<div id="CORE_headerIn">

<div id="hhsTop_CORE">
	<div id="hhsTopL_CORE"><span class="hhsTopL_pad_CORE">U.S. Department of Health and Human Services</span></div>
	<div id="hhsTopR_CORE"><span class="hhsTopR_pad_CORE"><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.hhs.gov/">www.hhs.gov</a></span></div>
</div>

<div id="CORE_titleOut">
<span id="CORE_title"><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm"><img src="https://cybercemetery.unt.edu/archive/oilspill/20120921185443im_/http://www.ihs.gov/GeneralWeb/WebComponents/CoreFiles/Header/images/title2.gif" alt="Indian Health Service: The Federal Health Program for American Indians and Alaska Natives" border="0" /></a></span>

<div id="CORE_search-aToZ">
	
        	
<div id="CORE_aToZheaderOut">
<dl class="CORE_aToZheader">
<dd class="CORE_aToZsmall">A - Z Index:</dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=A">A</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=B">B</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=C">C</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=D">D</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=E">E</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=F">F</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=G">G</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=H">H</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=I">I</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=J">J</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=K">K</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=L">L</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=M">M</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=N">N</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=O">O</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=P">P</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=Q">Q</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=R">R</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=S">S</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=T">T</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=U">U</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=V">V</a></dd>
<dd><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=AtoZ&option=W">W</a></dd>
<dd>X</dd>
<dd>Y</dd>
<dd>Z</dd>
<dd>#</dd>
</dl>
<div style="clear: both;"></div>
</div>


<div class="CORE_searchContainer">
<form name="IHS" method="GET" action="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://search.hhs.gov/search">

<input type="hidden" name="entqr" value="0">
<input type="hidden" name="output" value="xml_no_dtd">
<input type="hidden" name="sort" value="date:D:L:d1">
<input type="hidden" name="ud" value="1">
<input type="hidden" name="client" value="ihs">
<input type="hidden" name="oe" value="UTF-8"><input type="hidden" name="ie" value="UTF-8">
<input type="hidden" name="proxystylesheet" value="ihs">
<input type="hidden" name="site" value="ihs">

<input onfocus="this.value=''" type="text" name="q" size="25" maxlength="256" value="Search ihs.gov" CLASS="CORE_searchField" id="Search"><label for="Search"><input name="Submit" type="image" class="CORE_goBtn" value="Go" src="https://cybercemetery.unt.edu/archive/oilspill/20120921185443im_/http://www.ihs.gov/GeneralWeb/WebComponents/Navigation/NavBars/images/goBtn.gif" alt="Search Now"><span style="display: none">Search</span></label>
 </form>
</div>

</div>
</div>

<div id="CORE_crumbsLoginContainer">
	<div id="CORE_crumbs">

		<a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm">IHS Home</a>
		

			<img border="0" src="https://cybercemetery.unt.edu/archive/oilspill/20120921185443im_/http://www.ihs.gov/GeneralWeb/WebComponents/CoreFiles/Header/images/crumbArrow.gif" alt="" height="5" width="3" style="margin: 0px 4px 1px 1px;" /><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=Medical">Medical Programs</a>
                        
		
</div>
    <div id="CORE_log">


<a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/feedback/">Give Us Feedback</a></div>
</div>

</div>

				</div>
                </div>
				<div id="CORE_innerShell">
					<div id="CORE_contentContainer">
						<div id="CORE_contentContainer2">


<a name="skipIHSheader"></a>
<table width="100%"  border="0" cellspacing="0" cellpadding="0" summary="Site Content">
<tr valign="top">
<td width="150" id="menu">


<div id="leftMenu">

<div id="leftMenuTop">
<ul>
<li><a href="index.cfm" title="NC4 home page with links to all the Chief Clinical Consultants">NC4
Home</a></li>
<li><span class="noLine"><a href="index.cfm?module=mission" title="Mission/Who We Are">Mission/Who
We Are</a></span></li>
<li><a href="index.cfm?module=accessing" title="Accessing Services: Phone and written consultations, site visits and national meetings">Accessing
Services</a></li>
<li><a href="index.cfm?module=links" title="Activities, conferences and links to other web sites">Activities
and Links</a></li>
<li><a href="index.cfm?module=accessing#aihConf"> Advances in Indian Health Conference</a></li>
<li><a href="index.cfm?module=asbi">Alcohol Screening and Brief Intervention</a></li>
<li><a href="index.cfm?module=clinguid" title="Clinical Guidelines - A to Z postings and organ systems">Clinical
  Guidelines</a></li>
<li><a href="index.cfm?module=cred" title="Credentialing & Privileging/Risk Management documents in PDF">Credentialing & Privileging
  / Risk Management</a></li>

<li class="noLine"><a href="index.cfm?module=contactus" title="Address, phone and email contact info for all Chief Clinical Consultants">Contact
  Us</a></li>
</ul>
</div>

<div class="leftMenuIn">
<ul>
<li>Addiction Medicine and Pain Care (Vacant)</li>
<li><a href="index.cfm?module=apn" title="Ms. Ursula Knoki-Wilson, CCC for Advanced Nurse Practitioners">Advanced
Nurse Practitioners</a></li>
<li><a href="index.cfm?module=anes" title="Dr. Diane Pond, CCC for Anesthesiology">Anesthesiology</a></li>
<li><a href="index.cfm?module=dental" title="Dr. Todd Smith, CCC for Dentistry">Dental
Consultant</a></li>
<li><a href="index.cfm?module=em" title="Dr. James G. Flaherty, CCC for Emergency Medicine">Emergency
Medicine </a></li>
<li><a href="index.cfm?module=fp" title="Dr. Ann Bullock, CCC for Family Medicine">Family Medicine
</a></li>
<li>Internal
Medicine (Vacant)</li>
<li><a href="index.cfm?module=neph" title="Dr. Andrew Narva, CCC for Nephrology (Kidneys)">Nephrology
(Kidneys)</a></li>
<li><a href="index.cfm?module=obgyn" title="Dr. Jean Howe, CCC for Obstetrics/Gynecology">Obstetrics/
Gynecology</a></li>
<li><a href="index.cfm?module=oph" title="Dr. James Cox, CCC for Ophthalmology">Ophthalmology</a></li>
<li><a href="index.cfm?module=opt" title="Dr. Michael A. Candreva, CCC for Optometry">Optometry</a></li>
<li><a href="index.cfm?module=om" title="Dr. John Vanderhoof, CCC for Orthopedic Medicine">Orthopedic
Medicine</a></li>
<li><a href="index.cfm?module=peds" title="Dr. Steve Holve, CCC for Pediatrics">Pediatrics</a></li>
<li><a href="index.cfm?module=pt" title="CAPT Scott Gaustad, CCC for Physical Rehab Services">Physical
Rehab Services</a></li>
<li><a href="index.cfm?module=pas" title="CAPT Gary M. Cole, CCC for Physician Assistants">Physician
Assistants</a></li>
<li><a href="index.cfm?module=pod" title="Dr. Eugene Dannels, CCC for Podiatry">Podiatry</a></li>
<li><a href="index.cfm?module=psy" title="Peter Stuart, MD, National Consultant for Psychiatry">Psychiatry</a></li>
<li class="noLine"><a href="index.cfm?module=surg" title="Laura Tillman, MD, CCC for Surgery">Surgery</a></li>
</ul>
</div>


</div>

</td>
<td width="20"><img src="images/crnr.gif" alt="Rounded corner graphic" width="20" height="20"></td>

<td>

<div id="header">
<a href="index.cfm#top"><img src="images/hdr.gif" alt="National Council of Chief Clinical Consultants" width="351" height="110" border="0"></a>

</div>


<table width="100%" border="0" cellpadding="0" cellspacing="0">
<tr>
<td valign="top">
<h1>Clinical Resources</h1>
</td>
</tr>
<tr>
<td colspan="3" valign="top">
<div id="subHead"><img src="images/nc4SubH.gif" alt="" width="6" height="23" hspace="0" vspace="0">Clinical
Forms: Organ System</div></td>
</tr>
<tr>
<td colspan="3" valign="top" class="content"><table width="100%"  border="0" cellpadding="2" cellspacing="0" id="organNav">
<tr valign="top">
<td width="33%"><strong><a href="#ch">&middot;</a></strong> <a href="#ch">Child
Health</a><a href="#prev"> </a></td>
<td width="2%" rowspan="5">&nbsp;</td>
<td width="65%"><strong>&middot;</strong> <a href="#endocrine">Endocrine</a></td>
</tr>
<tr valign="top">
<td><strong>&middot;</strong> <a href="#hema">Hematology</a></td>
<td><strong>&middot;</strong> <a href="#prev">Prevention/Health Care Delivery</a></td>
</tr>
<tr valign="top">
<td><strong>&middot;</strong> <a href="#proc">Procedures</a></td>
<td><strong>&middot;</strong> <a href="#radio">Radiology</a></td>
</tr>
<tr valign="top">
<td><strong>&middot;</strong> <a href="#resp">Respiratory</a></td>
<td><strong>&middot;</strong> <a href="#rheum">Rheumatology</a></td>
</tr>
<tr valign="top">
<td><strong>&middot;</strong> <a href="#subAbuse">Substance Abuse</a></td>
<td><strong>&middot;</strong> <a href="#womenHealth">Women's Health</a><br />
</td>
</tr>
</table><br />
<div id="cgNav">
<div id="cgNavIn">
<ul>
<li style="font-size: 1.3em; font-weight: bold;">Other Clinical Resources</li>
<li><strong>National Comprehensive Guidelines<br />
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</strong><a href="index.cfm?module=clinguid">A - Z</a> &#8226; <a href="index.cfm?module=organSys">Organ System</a> &#8226; <a href="index.cfm?module=clearHouse">Clearinghouse/Agency</a></li>

<li><strong>Indian Health Clinical Guidelines<br />
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</strong><a href="index.cfm?module=guidesA-Z">A -
Z</a> &#8226; <a href="index.cfm?module=ihcgOrg">Organ System</a></li>

<li><strong>Clinical Forms</strong><br />
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="index.cfm?module=forms">A - Z</a> &#8226; <a href="index.cfm?module=formsOrgSys">Organ
System</a></li>

<!--
<li><a href="#">Performance Improvement Projects</a></li>
  -->
</ul>
</div>
</div>

<p><a name="ch"></a><strong>Child Health</strong> </p>
<ul>
<li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.aafa.org/pdfs/childcard_allergyaction_card.pdf"><strong>Asthma
card - child care</strong>,
Allergy and Asthma Foundation of America </a>
</li>
</ul>
<p><a href="#top">Top</a></p>
<p><strong><a name="endocrine"></a>Endocrine</strong></p>
<p><strong>Diabetes Mellitus</strong></p>
<ul>
<li> <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/DMgTool11210.pdf">Diabetes in Pregnancy Chart Tool</a> <span class="tiny">[PDF 52k]</span></li>
<li><strong> Insulin
  Sliding Scale</strong>
  <ul>
    <li> <a href="Documents/Insulin%20Sliding%20Scale%20Inpatient%20Form%20(WR).doc">Insulin
      Sliding Scale Inpatient Form (WR)</a> <span class="tiny">[WORD 52k]</span></li>
    <li><a href="Documents/SSI%20MAR%20Agressive%20(WR).doc">SSI MAR Agressive (WR)</a> <span class="tiny">[WORD
      131k]</span></li>
    <li><a href="Documents/SSI%20MAR%20Back%20(WR).doc">SSI MAR Back (WR)</a> <span class="tiny">[WORD
      88k]</span></li>
    <li><a href="Documents/SSI%20MAR%20Custom%20(WR).doc">SSI MAR Custom (WR)</a> <span class="tiny">[WORD
      155k]</span></li>
    <li><a href="Documents/SSI%20MAR%20Mild%20(WR).doc">SSI MAR Mild (WR)</a> <span class="tiny">[WORD
      131k]</span></li>
    <li><a href="Documents/SSI%20MAR%20Mod%20(WR).doc">SSI MAR Mod (WR)</a> <span class="tiny">[WORD
      132k]</span></li>
  </ul>
</li>
</ul>
<p><a href="#top">Top</a></p>
<p><strong><a name="hema" id="hema"></a>Hemataology</strong></p>
<ul><li><a href="Documents/BloodtransfusionConsent(WR).pdf">Blood Transfusion Consent (WR)</a> <span class="tiny">[PDF 315k]</span></li>
</ul>
<p><a name="prev"></a><strong>Prevention/Health Care Delivery</strong> </p>
<ul>
<li> <a href="Documents/PCC.pdf">Elder Exam PCC Comprehensive (IHS 865) </a> <span class="tiny">[PDF
643k]</span></li>
<li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/M/documents/tobacco_template.doc" class="style3">Tobacco
  Cessation, Cherokee</a>
</li>
</ul>
<p><a href="#top">Top</a></p>
<p><strong><a name="proc" id="proc"></a>Procedures</strong></p>
<ul>
<li><a href="Documents/ArthrocentesisConsent(WR).pdf">Arthrocentesis Consent (WR)</a> <span class="tiny">[PDF 315k]</span></li>
<li><a href="Documents/CentralLineConsent(WR).pdf">Central Line Consent (WR)</a> <span class="tiny">[PDF 317k]</span></li>
</ul>
<p><strong><a name="radio" id="radio"></a>Radiology</strong></p>
<ul><li><a href="Documents/ContrastIntravenousConsentForm(WR).doc">Contrast Intravenous Consent Form (WR)</a> <span class="tiny">[WORD 26k]</span></li>
</ul>
<p><a name="Resp"></a><strong>Respiratory</strong> </p>
<ul>
<li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.aafa.org/pdfs/childcard_allergyaction_card.pdf" class="style4">Asthma
card - child care</a><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.aafa.org/pdfs/childcard_allergyaction_card.pdf">,
Allergy and Asthma Foundation of America</a></li>
<li> <a href="Documents/Pneumoniaadmissionorders(PIMC).doc">Pneumonia Admission
Orders (PIMC)</a> <span class="tiny">[WORD 38k]</span></li>
</ul>
<p><a name="rheum" id="rheum"></a><strong>Rheumatology</strong> </p>
<ul><li><a href="Documents/Infliximab&EtanerceptConsent(WR).pdf">Infliximab & Etanercept Consent (WR)</a> <span class="tiny">[PDF 309k]</span></li>
</ul>
<p><a name="subAbuse" id="subAbuse"></a><strong>Substance Abuse</strong></p>
<ul>
<li>
<p><a href="Documents/AlcoholWithdrawalAssessmentSheets(PIMC%20Apr%2005).doc">Alcohol
Withdrawal Assessment Sheets (PIMC Apr 05)</a> <span class="tiny">[WORD 140k]</span></p>
</li>
<li>
<p><a href="Documents/AlcoholWithdrawalProtocol(PIMCApr05).doc">Alcohol Withdrawal
Protocol (PIMC Apr 05)</a> <span class="tiny">[WORD 55k]</span></p>
</li>
</ul>
<p><a href="#top">Top</a></p>
<p><a name="womenHealth"></a><strong>Women's Health</strong></p>
<ul>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/IronIVOrders.pdf">Anemia in Pregnancy: IV Iron Order Set</a> <span class="tiny">[PDF-52KB]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/ATflowsheet4811b.pdf">Antenatal Testing Guideline and Flow sheet</a> <span class="tiny">[PDF]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/JehWitness42011B.pdf">Blood Product Education Tool</a> <span class="tiny">[PDF]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/DMgTool11210.pdf">Diabetes in Pregnancy Chart Tool</a> <span class="tiny">[PDF]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/HTNtool.pdf">Hypertension in Pregnancy Chart Tool</a> <span class="tiny">[PDF]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/STDCDC2010Summary.pdf">Sexually Transmitted Disease Treatment, CDC Summary  Chart, 2010</a> <span class="tiny">[PDF]</span></li>
  <li><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/MedicalPrograms/MCH/F/documents/TOLACconsent111010b.pdf">Trial of labor after Cesarean Education Tool/Consent</a> <span class="tiny">[PDF]</span><br>
  </li>
</ul>

<p><a href="#top">Top</a></p>
<hr>
<p><strong>Please note, regarding the material described above:</strong></p>
<ul class="disclaim">
<li>The material presented is meant to further your local discussion of best practices. It is not meant to provide a template for care. Please share it with your local clinical staff and alter to fit your local needs</li>
<li>Material for each topic on these sites has been developed by other providers based on that person's clinical judgment and experience as an expert in that field</li>
<li>The material does not represent official policy or recommendations of the Indian Health Service or the other agencies involved</li>
<li>Its publication should not be construed as excluding other acceptable methods of handling similar problems</li>
<li>Please let the <a href="mailto:NC4WebAdmin@na.ihs.gov">site coordinator</a> know if you have questions or concerns about any of the material. Thanks</li>
</ul>
<p>&nbsp;</p></td>
</tr>
</table>


</td>
</tr>
<tr>
<td colspan="3" id="footer">
<p>For additional information, contact the <a href="mailto:scott.gaustad@ihs.gov" class="linkit">NC4 Website Administrator</a></p>
</td>
</tr>
</table>


						</div>
					</div>
				  </div>
				<div id="CORE_footerBorder">
                <div id="CORE_footer">

					
<div id="CORE_footerIn">

	<p id="CORE_footerText">This website may require you to <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/GeneralWeb/WebComponents/Downloads/Plugins.cfm">download plug-ins</a> to view all content.</p>


<p id="CORE_footerText"><a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.usa.gov/"><img src="https://cybercemetery.unt.edu/archive/oilspill/20120921185443im_/http://www.ihs.gov/images/usaGov.gif" alt="usa.gov link" width="76" height="29" align="absmiddle" border="0" /></a> &nbsp; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=Accessibility">Accessibility</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=Disclaimers">Disclaimer</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/GeneralWeb/HelpCenter/CustomerServices/FAQ/">FAQs</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=PrivacyPolicy">Website
Privacy Policy</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html">Plain Writing Act</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/FOIA/">Freedom
of Information Act</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/AdminMngrResources/HIPAA/">HIPAA</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/AdminMngrResources/EEO/index.cfm?module=noFear">No Fear</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=ihsGlossary">Glossary</a> &middot; <a href="https://cybercemetery.unt.edu/archive/oilspill/20120921185443/http://www.ihs.gov/index.cfm?module=Contact">Contact</a>  

<p id="CORE_footerText">Indian Health Service (HQ) - The Reyes Building, 801 Thompson Avenue, Ste. 400 - Rockville, MD 20852</p>
</div>


				</div>
                </div>
			  </div>
            </div>
		</div>
	</div>
   <div id="CORE_bottomGradient"></div>


</body>
</html>