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Appendix Documents for the Rudy Wellness Center
Info Sheet

Document Number: RWC--106d Revision #: 1.0
Document Owner: Executive VP Date Last Updated: 07/11/2013
Primary Author: Dean of the School of Nursing and Health Sciences and Health Sciences Status: Approved
Date Originally Created: 05/22/2012

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Appendix Documents


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Attachments
Patient Registration Form - Appendix A
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Medical History Form - Appendix B
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Notice of HIPPA Privacy Practices - Appendix C
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Patient Agreement - Appendix D
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Client Information Handout - Appendix E
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Criteria for Outside Referral - Appendix F
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Medical Record Release - Appendix G
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Medical Record Release - Appendix G1
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Receipt of Confidential Record - Appendix H
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Client Visit Survey - Appendix I
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Guidelines for Managing Volatile Clients - Appendix J
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Sexual Assault, Harassment, Threats, and Violence - Appendix K
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What Should You Do After a Sexual Assault or Rape - Appendix L
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Program Evaluation - Appendix M
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Subject Experts
The following may be consulted for additional information.
Dean of the School of Nursing and Health Sciences and Health Sciences

Executive VP

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Regulations
Standards of good practice
University governance

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