Document Repository

WIC Forms & Resources

Forms – Online Submission

• WIC Rights, Responsibilities and Consent 
• WIC Rights, Responsibilities and Consent – Spanish
• WIC Consent with SWDH Programs
• WIC Consent with SWDH Programs – Spanish
• WIC Proof of Lawful Presence Attestation Form
• WIC Proof of Lawful Presence Attestation Form – Spanish

Resources

• WIC Participant Rights, Responsibilities and Consent – EN and SP

Behavioral Health Forms

• Telehealth Informed Consent [PDF]
• Telehealth Informed Consent [Online Submission]
• Magellan Bill of Rights [PDF]
• Magellan Bill of Rights  [Online Submission]
• Release of Information [PDF]
• Release of Information [Online Submission]
• BH Informed Consent and Service Agreement [PDF]
• BH Informed Consent and Service Agreement [Online Submission]
• Minors Authorization Blanket Consent [PDF]

 Formularios-Espanol

• Consentimiento Informado para Telemedicina
• Carta de Derechos de Magellan
• Consentimiento Informado y Acuerdo de Servicios
• Autorización para Divulgación de Información

Informational Documents

• Notice of Privacy Practices
• Patient Rights and Responsibilities
• Mental Health Fee Schedule

Informativos-Espanol

• Aviso de Prácticas de Privacidad
• Derechos y Responsabilidades del Paciente

C. Difficle

Enhanced Barrier Precautions

LTCF Flu Outbreak Tool Kit

• Algorithms for Prevention and Management of Clostridium Difficile
• Hand Hygiene Assessment
• Environmental Cleaning Assessment
• Early Identification and Containment of CDIContact Precautions Signage
• Clostridiun Difficle Guidelines
• Antibiotic Stewardship Assessment

• Enhanced Barrier Precautions (EBP)
• Enhanced Barrier Precautions (EBP) Presentation

• CDC Contamination Cleaning
• Tool Kit Intro
• PCP Letter Template
• Influenza Surveillance Update
• Influenza outbreak Toolkit
• Help Protect Our Residents
• Flu Specimen Collection Poster
• Flu Outbreak Signage
• Flu Line List Template

Norovirus

Misc

• Line List Template
• Norovirus Outbreak Toolkit

• Candida Auris Outbreak Toolkit
• Prevention And Control of Respiratory Illness in LTCFs
• NACCHO LHD Infection Prevention Control Toolkit
• COVID-19 Guidance ALF and ICF
• COVID 19 Guidance SNF

Daycare- ARI

Hand Foot and Mouth

School- Acute GI Toolkit

School- ARI

School- Chicken Pox

School- Impentigo

School- Head Lice

School- Measles

School- Ringworm

School- Pertussis