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Site Updated
Friday, February 03, 2012



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Long-Term Care - Consents
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CP1800

Informed Consent for Pneumococcal and Influenza Vaccine

CP1803

Release of Responsibility for Leave of Absence

CP1809

Release of Responsibility for Leave of Absence

MP5406

Out of Hospital/DNR Order

MP5411

Medication Release/Receipt

MP5437

Advanced Directives/Medical Treatment Order

MP5469

Informed Consent for use of Restraints

MP5476

Consent for Use of Side Rails

MP5540

Risk - Benefit Acknowledgement Form

MP5563

Consent for Use of Psychoactive Medications

MP5564

Consent for Use of Psychoactive Medication Therapy

MPH001

Authorization for Use or Disclosure of PHI (HIPAA)

MPH002

Request to Restrict the Use and Disclosure of PHI (HIPAA)

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