Medical/Dental Visit report form (SLS, Care home, Case Manager, Social Worker)

I finally got the complete information from my staff for every medical/dental/psych visit when I started giving them this form.

I would fill out the medical appointment information and reason for the appointment and then have the staff ask the CNA or Nurse to fill out the medical information.

Every time they used this form, the medical staff would comment about how simple it was and that they wished everyone would bring a form like this.