Chart Tools
Photo of Clinicians

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.

Dot 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 Español (Word)    (05/06/04)

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

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

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

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

Adult Physical Evaluation (pdf) (word) (12/30/09)

Adult Health History-(Subjective Data Base) (pdf) (word) (12/30/09)

Annual Education Sheets (pdf) (12/30/09)

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)

 Prenatal Chart Form that Includes HIV Testing (9/08)

Problem List (Word) (10/99)

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

 Sample Hospital Protocol for HIV Exposed Newborn (9/08)

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

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

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)

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