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

Current as of February 2010
Internet Citation: Appendix B10: Primary Care Provider Fax Report and Orders: The Falls Management Program Manual. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapb10pcp.html