WellHealth Worx File Directory
Forms and documents for WellHealth Worx patients and employees.
For WHW Staff
Paitent Forms
Manual
Admin Forms-Fax_Cover_Sheet _071520
1 file(s) 47.47 KB
Patient Forms- Virtual Care Policy-Covid Addendum V3 7.13.20.pdf
1 file(s) 143.25 KB
Patient Forms-AMA_Acknowledgement_ReleaseofLiability_072920
1 file(s) 54.86 KB
Patient Forms-Controlled Substance_Agreement _071520_REVISED
1 file(s) 92.55 KB
Patient Forms-General_Consent_Medical 9.2.2020
1 file(s) 97.30 KB
Patient Forms-General_Consent_Occ health
1 file(s) 93.13 KB
Patient Forms-Notice of Privacy Practices with Occupational Health.pdf
1 file(s) 146.97 KB
Patient Forms-Notice of Privacy_Practices_Policy_Receipt _071520
1 file(s) 49.15 KB
Patient Forms-Patient_Health_History_071520_REVISED
1 file(s) 135.20 KB
Patient Forms-Patient_Responsibilities
1 file(s) 46.87 KB
Patient Forms-Vaccination_Consent_(Spanish)_071520
1 file(s) 59.79 KB
Patient Forms-Vaccination_Consent_071520
1 file(s) 57.21 KB
Patient Forms-Virtual Care Policy-6-19v6
1 file(s) 169.49 KB
Physical Form-DOT Medical Examination_2020
1 file(s) 1.20 MB
Physical Form-DOT Medical Examiners_Certificate 2020
1 file(s) 750.51 KB
WHW-Advisory Board Member Confidentiality Agreement - 4839-5967-1211 v3
1 file(s) 47.50 KB
WHW-Confidentiality Agreement -V1
1 file(s) 47.00 KB
WHW-ERP_Bloodborne Pathogen_Policy & Acknowledgment_REVISED_092120
1 file(s) 160.90 KB
WHW-ERP-Biohazard_Policy_Acknowledgment_071520_REVISED
1 file(s) 54.69 KB
WHW-ERP-Vaccination_Hepatitis_B_Declination_071520
1 file(s) 41.90 KB
HIPAA Privacy
Notice of Privacy Practices with Occupational Health
1 file(s) 145.96 KB
NOTICE OF PRIVACY PRACTICES- ACKNOWLEDGMENT OF RECEIPT
1 file(s) 55.92 KB
NOTIFICATION OF AMENDMENT TO PROTECTED HEALTH INFORMATION
1 file(s) 48.53 KB
PATIENT'S AUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION
1 file(s) 89.57 KB
PATIENT'S REQUEST ALTERNATIVE METHOD OF CONFIDENTIAL COMMUNICATIONS
1 file(s) 20.00 KB
PATIENT'S REQUEST FOR AN ACCOUNTING OF DISCLOSURES
1 file(s) 20.00 KB
Patient's Request to Amend Protected Health Information
1 file(s) 88.76 KB
PRIVACY COMPLAINT FORM
1 file(s) 51.10 KB
PRIVACY COMPLAINT RESOLUTION FORM
1 file(s) 51.90 KB
REQUEST FOR ACCESS TO PROTECTED HEALTH INFORMATION
1 file(s) 94.12 KB
REQUEST FOR DECEASED PERSON’S PROTECTED HEALTH INFORMATION FORM
1 file(s) 87.03 KB
RESPONSE TO ACCOUNTING OF DISCLOSURES OF PROTECTED HEALTH INFORMATION
1 file(s) 56.54 KB
RESPONSE TO REQUEST FOR AN ACCOUNTING OF DISCLOSURES
1 file(s) 56.66 KB
RESPONSE TO REQUEST TO AMEND PROTECTED HEALTH INFORMATION
1 file(s) 90.27 KB
SECURITY AND PRIVACY TRAINING CERTIFICATION
1 file(s) 50.94 KB
POET
POET _Transportation_062620
1 file(s) 79.56 KB
POET_Health__Systems_Reveiw_9.4.2020
1 file(s) 68.50 KB
POET_Informed_Consent_9.4.20
1 file(s) 86.34 KB
POET_Medical_Release__Clearance-Cardiac_062620
1 file(s) 67.10 KB
POET_Medical_Release_Clearance_non-cardiac_062620
1 file(s) 56.18 KB
POET_Release of Claims & Hold Harmless
1 file(s) 111.95 KB
POET_Testing_Report_062620
1 file(s) 56.27 KB
POET_Transportation Musculoskeletal Screen_062620
1 file(s) 65.03 KB
POET_Warehouse_09.10.2020
1 file(s) 74.38 KB
Other
Down EHR SOP
1 file(s) 45.60 KB
Documentation Cloning 5.07
1 file(s) 21.87 KB
Chart Audit Tool_092120
1 file(s) 59.12 KB
Chapter 7 WHW edits
1 file(s) 54.98 KB
1. Policy Development and Maintenance_Revised
1 file(s) 126.63 KB
2. Personnel_Revised
1 file(s) 155.56 KB
3. Scheduling_Revised
1 file(s) 179.05 KB
4. Patient Administrative Services
1 file(s) 139.67 KB
5. Medical Records
1 file(s) 241.67 KB
6. Clinical Care
1 file(s) 217.26 KB
7. Medication Management
1 file(s) 173.72 KB