Core Clinical Service Guide Feedback

Please use the questions and space below to indicate any issues/concerns regarding utilization of the Core Clinical Service Guide during clinical practice. Items may include information that you feel is missing, the format of specific information and/or content that you think is not needed.

Question Title

* 1. Please complete the information below in case clarification is needed regarding your comments.

Name:

LHD:

Phone:

Email:

Question Title

* 2. Please select the section(s) of the Core Clinical Service Guide that you wish to comment on.

Introduction & Signature Page

Cancer Screening

Emergencies

Follow-up / Internal Tracking / Referral

Family Planning

HIV

Immunizations

Lab

Lead

Pediatrics

Prenatal

Rabies

STD

TB: Evaluation of Immigrants and Refugees

WIC

Other (please specify)

Question Title

* 1. Please complete the information below in case clarification is needed regarding your comments.

Question Title

* 2. Please select the section(s) of the Core Clinical Service Guide that you wish to comment on.

Question Title

* 3. Please indicate your specific comment or concern regarding this section(s). If possible list the page number and other specific information.