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Abnormal Involuntary Movement Scale (AIMS)

$11.95 50-sheet pad
+ 4.95 s&h

Used to detect Extra-pyramidal symptoms, such as those associated with tardive dyskinesia.

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Active/Inactive Problem List

$11.95 50 sheet pad
+ 4.95 s&h

Active/Inactive Problem List: A complete medical history on one sheet of paper. Designed to accompany the consumer to all medical or acute case settings in lieu of the bulky record.

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Admission/Discharge Summary

$11.95 50 sheet pad
+4.95 s&h

Tracks vital information relative to admission and discharge from an acute care setting.

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Bowel Elimination Record

$11.95 50 sheet pad
+4.95 s+h

Bowel Elimination Record: This one sheet form allows for documentation of bowel elimination, recording of prn medications and colostomy care and tracking of changes in bowel management.

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Bowel Function Assessment Form

$11.95 50 sheet pad
+4.95 s&h

Bowel Function Assessment Form: This one sheet form allows assessment of bowel patterns, nursing diagnosis, and designation of objective interventions.

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Case Manager Summary

$11.95 50 sheet pad
+4.95 s&h

Monthly Case Manager Summary: A form for case managers to summarize monthly changes in individual status, including accident/injuries, behavioral issues, medication self administration, nutritional analysis, ER/hospitalizations, medical or other consults, and team communication and decision-making for these issues.

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Client's Lab Work

$11.95 50 sheet pad
+4.95 s&h

Allows compilation of information regarding response to medication for review by a health practitioner.

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Comprehensive Assessment: Behavior Tracking Chart

$11.95 50 sheet pad
+4.95 s&h

Designed to identify antecedents, conditions and consequences of behaviors, eg. times of day, month, where gehvior happens, who is present, what happened before and after. Also included is a checklist to differentiate behavior from mental illness or other conditions.

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Comprehensive Assessment: Findings and Planning Sheet

$11.95 50 sheet pad
+4.95 s&h

Allows tracking of Factors, findings, Interventions, who has responsibility, and target dates for health, medications, psychiatric issues, and behavioral conditions.

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Daily Nutritional Intake Tracking Sheet

$11.95 50 sheet pad
+4.95 s&h

Tracks percentage of Intake by food group for 24 hours.

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Data Collection For Choking Incidents

$11.95 50 sheet pad
+4.95 s&h

Data Collection For Choking Incidents: Assists with the analysis of relevant data to determine root cause of choking events as well as documentation of remedial action and follow-up for adverse outcomes

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Data Tracking Log

$11.95 50 sheet pad
+4.95 s&h

Data Tracking Log: Tracks monthly changes essential to monitoring change on the 22 rating areas of the Health Risk Screening Tool

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Detection of Side Effects Scale (Doses):

$11.95 pad 50 forms

Detection of Side Effects Scale (Doses): Checklist for identifying common side effects of a wide range of medications.

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Diabetic Control Record

$11.95 50 sheet pad
+4.95 s&h

Diabetic Control Record: Insulin Site Rotation directions plus tracking of blood sugars, insulin sites and types.

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Dietician Nutritional Intervention Screening

$11.95 50 sheet pad
+4.95 s&h

Screening instrument allowing clinical dietician to determine nutritional risk.

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Dining Checklist

$11.95 50 sheet pad
+4.95 s&h

Provides a format for review of direct care support during mealtime.

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Flow Record

$11.95 50 sheet pad
+4.95 s&h

Flow Record: Direct care professional recording for ADL’s, diet intake, menses, voiding and BM’s, bathing and hygiene. Tracks by shift for 31 days.

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Flow Record for Health Care Levels 1-4

$11.95 50 sheet pad
+4.95 s&h

Flow Record for Health Care Levels 1-4: Allows tracking of 31 days of relevant health care data for individuals at low and moderate health risk including, as appropriate, vital signs, meal consumption, bowel function, skin status, intake and output, enteral feedings and others.

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Flow Record for Health Care Levels 5-6

$11.95 50 sheet pad
+4.95 s&h

Flow Record for Health Care Levels 5-6: Allows tracking of 31 days of relevant health care data for individuals at low and moderate health risk including, as appropriate, vital signs, meal consumption, bowel function, skin status, intake and output, enteral feedings and others.

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Focused Case Review Of Individuals Receiving Nutrition By Tube

$11.95--13 forms/8 pages
+4.95 s&h

Focused Case Review Of Individuals Receiving Nutrition By Tube: Examines management of persons on enteral feeding tubes and assesses the compliance with current standards of health care management.

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Focused Case Review/Unexplained Weight Loss

$11.95--13 forms/8 pages
+4.95 s&h

Focused Case Review For Individuals At Less Than 80% Of Ideal Body Weight Or Experiencing Unexplained Weight Loss: Assesses the comprehensiveness of assessment and management of persons at high nutritional risk.

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General Care

$11.95 50 sheet pad
+4.95 s&h

Discharge instructions for treatment as an outpatient.

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Health Care Forms CD

CD with all the forms in adobe format
$139.95

McGowan Consultants has developed a variety of forms for health and wellness management that may be useful in a variety of residential and day program settings. These include forms that document seizure management; active and inactive medical histories; information for medication reviews, physician referral forms, nutritional management monitoring reports; self-administration of medication assessments, among others.

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Health Care Forms Three Ring Binder for copying

$149.95

All of our various forms in sheet protectors. May be copied for individual use.

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Health Care Passport

$11.95 sheet pad
+4.95 s&h

Health Care Passport: Provides a concise, accurate and up-to-date health summary of the person’s medical history and organized so that it can be kept with the person at all times.

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Health Progress Record Sheet

$11.95 50 sheet pad
+4.95 s&h

Health Progress Record Sheet: Allows 12 months of monthly tracking of vital signs, bowel function, feeding, intake and output, acute events including ER/hospital admissions and mental status.

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Health Risk Screening Tool Data Worksheet

$11.95 50 sheet pad
+4.95 s&h

Health Risk Screening Tool Data Worksheet: This form gathers basic data necessary to the completion of the Health Risk Screening Tool (HRST).

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Hydration Assessment

$11.95 50 sheet pad
+4.95 s&h

Hydration Assessment: Assesses for the presence of dehydration, edema or homeostasis including physical status, and lab values.

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Intake and Elimination Record

$11.95 50 sheet pad
+4.95 s&h

Tracks Bowel Elimination, Laxative, suppository, and enema use, voiding, emeses for 31 days.

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Lab Analysis Flow Sheet

$11.95 50 sheet pad
+4.95 s&h

Allows for comparison of a wide range of lab tests for four periods and assists in the quick analysis of change over time.

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Mealtime Pulse Oxymeter Study

$11.95 50 sheet pad
+4.95 s&h

Mealtime Pulse Oxymeter Study: A form for the use of a pulse oximeter to determine aspiration during swallowing or reflux during or following mealtime.

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Medical Fact Sheet

$11.95 25 forms-50 sheet pad
+4.95 s&h

Active and inactive health information, including current medications and treatments. Used to accompany a person to a health appointment or emergency treatment facility.

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Medication Errors and Omissions Report

$11.95 50 sheet pad
+4.95 s&h

Tracks medication error from discovery to resolution.

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Medication History

$11.95 50 sheet pad
+4.95 s&h

Allows historical tracking of all drugs by drug/dose/frequency,purpose, date began/stopped/and reason for stopping including problems, side effects and allergic reactions.

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Medication Review

$11.95 50 sheet pad
+4.95 s&h

Medication Review: Allows for analysis of the individual’s response (ether positive or negative) to medication.

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Medication Self-Administration Assessment Enteral Tube Route

$11.95 50 sheet pad
+4.95 s&h

Assesses ability for person to self administer medication through enteral tube.

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Menstrual and Breast Exam Calendar

$11.95 50 sheet pad
+4.95 s&h

Menstrual and Breast Exam Calendar: Tracks a years worth of menstrual and breast exam data.

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Mental Health Consultation Information Form

$11.95 50 sheet pad
+4.95 s&h

Information necessary for the mental health practitioner.

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Nursing Assessment

$11.95 50 sheet pad
+4.95 s&h

Looks at nursing documentation, assessment and follow-up of acute illnesses and injuries, preventative care and wellness, etc.

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Nursing Peer Review

$11.95--6 forms/20 pages
+4.95 s&h

Used for nurse to nurse assessment of quality of care.

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Nutritional Assessment

$11.95 50 sheet pad
+4.95 s&h

Nutritional Assessment: This form looks at weight, intake, body mass index, significant weight change, and relevant lab values to determine nutritional status.

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Nutritional Intervention Assessment

$11.95 4 page/20 forms
+4.95 s&h

Nutritional Intervention Assessment: This form (4 pages) synthesizes a wide range of intervention information.

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Nutritional Level Of Risk Checklist

$11.95 50 sheet pad
+4.95 s&h

Nutritional Level Of Risk Checklist: A simple one page format that allows determination of low, moderate or high nutritional risk.

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Nutritional Management Monitoring Report

$11.95 50 sheet pad
+4.95 s&h

Nutritional Management Monitoring Report: Analysis of 12 months of eating and nutritional data to establish a determination of stable, unstable or health care crisis.

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Nutritional Management Process Checklist

$11.95--8 forms/12 pages
+4.95 s&h

Nutritional Management Process Checklist: Asks questions regarding the critical components of a Nutritional Management Process, such as presence and function of a nutritional management committee, assessment of alteration in nutritional status, identification of at risk individuals, management of individuals with recurrent aspiration pneumonia, care of individuals with G-tubes, etc.

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Oral Medication Self-Administration Assessment

$11.95 4 page/20 forms
+4.95 s&h

Baseline assessment determine to determine individual's ability to consistently and safely self-medicate.

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Policy and Procedure: Constipation

$11.95--14 forms/6 pages

Policy and Procedure: Constipation. This is a model P and P for Goals, definitions, Procedures for Nursing Assessment, nursing interventions, health education and documentation for persons with constipation and other bowel function issues.

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Preventative Health Care, Children Health Maintenance Flow Sheet

$11.95 50 sheet pad
+4.95 s&h

Most current health care standards for medical and preventative health care for children ages 1 month through 17 years.

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Preventative Health Care, Health Maintenance Flow Sheet 50 and Over

$11.95 50 sheet pad
+4.95 s&h

Most current health care standards for medical and preventative health care by age groups.

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Preventive Health Care, Health Maintenance Flow Sheet Age 18 through 49

$11.95 50 sheet pad
+4.95 s&h

Most current health care standards for medical and preventative health care by age groups.

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Recognition of Side Effects Scale for Antiepileptic Drugs (Roses-Aed):

$11.95 50 sheet pad
+4.95 s&h

Recognition of Side Effects Scale for Antiepileptic Drugs (Roses-Aed): This scale allows the evaluation of the presence of anti-epileptic drug side effects.

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Referral Form for Medical Examination/Treatment

$11.95 50 sheet pad
+4.95 s&h

Referral Form for Medical Examination/Treatment: Provides information for the physician and allows for physician to provide written feedback to the facility.

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Seizure Episodes

$11.95 50 sheet pad
+4.95 s&h

A one page listing of seizure information for one individual over time.

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Seizure Report

$11.95 50 sheet pad
+4.95 s&h

Seizure Report: A simple format for assessing behavior before, during and after a seizure.

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Skin Condition Report

$11.95 50 sheet pad
+4.95 s&h

Skin Condition Report: Tracks skin breakdown for four different sites from initial discovery to different sites from initial discovery to resolution. Tracks Date, site, size and description, Rx and changes.

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Skin Management

$11.95 50 sheet pad
+4.95 s&h

Skin Management: Allows tracking of a range of skin condition factors (bluish, pinkish, ashen, warm, cool, clammy, swelling, redness, broken skin, decubitus stage and treatments over a 31 day period for a single individual.

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Swallowing Assessment

$11.95 50 sheet pad
+4.95 s&h

OT/Speech assessment format for persons with swallowing issues.

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Tube Feeding Record

$11.95 50 sheet pad
+4.95 s&h

Tube Feeding Record: Tracks a wide range of data, such as formula/water intake, checking of tube placement, flushing, residual, etc. for a single individual over a 31 day period.

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Weight Record

$11.95 50 sheet pad
+4.95 s&h

Weight Record: Allows weekly weight records for a four year period for a single individual.