Chart Tools

The Florida/Caribbean AIDS Education and Training Center is pleased to present a number of clinical charting forms to assist you in your practice. The Notation A,B,C represent variations of the same type form.

AETC - Best Forms (Word) (06/16/09)

Primary Care Workgroup Tools

Chronic Pain (2/2008)

Depression (2/2008)

Dyslipidemia (2/2008)

Substance Abuse (2/2008)

Adherence Assessment A (Word) (05/06/04)

Adherence Assessment A - En Español (Word) (05/06/04)

Adherence Assessment B (Word) (05/06/04)

Adherence Assessment B - En Espa ñ ol (Word) (05/06/04)

Adherence Assessment C (Word) (05/06/04)

Adherence Assessment C - En Espa ñ ol (Word) (05/06/04)

Admission Intake History A (Word) (05/06/04)

Admission Intake History B (Word) (05/06/04)

Adult Physical Evaluation (Word) (05/31/07)

Adult Health History-(Subjective Data Base) (Word) (05/31/07)

Annual Education Sheets (Word) (01/10/06)

Antiretroviral Case History (Word) (06/08/05)

Antiretroviral Use History (Word) (06/05/07)

Antiretroviral Use History – sample (Word) (06/05/07)

Authorization to Use or Disclose Protected Health Information (Word) (05/31/07)

Chart Abstraction Tool - HIV Obstetrics (Word) (07/01/04)

Clinic Visit H&P Flow Sheet SOAP (Word) (05/06/04)

Clinic Visit H&P Flow Sheet Detailed (Word) (05/06/04)

Comprehensive Flow Sheet (Word) (05/06/04)

Consults, Diagnostic Tests (Word) (05/31/07)

Medical Protocol Consistent with the Most Current Clinical Care Protocols (Word) (1/19/07)

Dental Health Flow Sheet (Word) (05/06/04)

HIV Baseline Labs Vaccine Flow Sheet A (Word) (05/06/04)

HIV Baseline Labs Vaccine Flow Sheet B (Word) (05/06/04)

Lab Flow Sheet A (Word) (05/06/04)

Lab Flow Sheet B (Word) (05/06/04)

Medical History Form that Includes HIV Risk Assessment (2/3/04)

Medication List (Word) (10/99)

Narcotic Prescription Information for Clients (Word) (10/16/06)

Order/referral Sheet (Word) (05/06/04)

Patient Treatment Contract English & Spanish (Word) (05/06/04)

Patient/Family/SO Education Flow Sheet (Word) (5/4/07)

St. Joseph’s Hospital Tampa Care Flow Sheet (Word) (11/30/07)

Perinatal HIV Rapid Testing Quality Assurance Data Sheet (Word) (06/08/05)

Prenatal Chart Form that Includes HIV Testing (2/3/04)

Problem List (Word) (10/99)

Progress Note (PDF) (Word) (10/31/08)

Sample Hospital Protocol for HIV Exposed Newborn (1/3/05)

Substance Use Assessment (Word) (05/06/04)

Vital Signs Flow Sheet (Word) (05/06/04)

Formedic also provides a nice collection of HIV-related patient record forms

Follow-Up Office Visit (Word) (03/23/04)

HIV Flow Sheet (Word)

X-Ray Flow Sheet (Word)

Immunization Initial Screening Flow Sheet (Word)

Selected Lab Flow Sheet (Word)

Pharmacy Medications Consultation Progress Note (Word)

OB/GYN HIV Counseling and Testing Labels (Word)

Women's Health Examination/PAP Test (Word)

We are grateful to the following individuals and agencies for allowing the AETC to use and adapt their documents:

Collier County H.D.
Florida/Caribbean AETC
Hendry Glades County H.D.
Hillsborough County H.D.
North Broward Hospital District
St. Joseph’s Hospital Tampa Care Clinic
USF College of Medicine