The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities

Appendix B10: Primary Care Provider Fax Report and Orders

[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. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapb10pcp.html