Appendix B10: Primary Care Provider Fax Report and Orders

The Falls Management Program Manual

[D] Select for Text Description for all images.

1. Fax Cover Sheet

Figure 18 Image

2. Falls Assessment Report

Figure 19 Image

3. Fax Back Orders

Figure 20 Image

Page last reviewed October 2014
Internet Citation: Appendix B10: Primary Care Provider Fax Report and Orders: The Falls Management Program Manual. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapb10pcp.html