|
| Screening: Comprehensive |
Parent and Youth Screening Checklists
Shriners Hospital for Children These short one-page screening
tools are designed to identify comprehensive unmet needs
of children/youth served by Shriners Hospitals for Children
in outpatient settings. Any positive response indicates
an unmet need and generates a referral to a care coordinator
for further assessment. One side of the tool is designed
to be completed by the parent/caretaker and the other
the child/youth. There are two versions of each tool,
one more detailed than the other. These tools have been
selected by SHC as model care coordination screening tools.
|
Parent Completed
Screening Tool
[word]
[pdf]
Parent Completed
Check List
[word]
[pdf] |
| Screening: Comprehensive |
Acuity Self-Assessment:
Shriners Hospital for Children - Intermountain
These short one-page tools are designed to provide families
and youth with opportunity to self-assess and determine
their own care coordination acuity status. Based on family/youth
responses, care coordinators can triage those needing
their services during a specific encounter. |
Young Adult Acuity Rating
[word]
[pdf] |
Exeter Pediatrics "Mini-survey"
Surveys for patients and families to be given before visit,
after the visit and another that provides an opportunity
for the doctor and other health professionals to evaluate
how they are meeting the needs of their patients. |
www.medicalhomeinfo.org/
tools/survey.html |
| Screening: Transition-focused |
Planning Your Future
Shriners Hospitals for Children
This short one-page screening tool is designed to identify
youth with specific transition needs and concerns. It
allows care coordinators or other providers to focus time
and attention on youth with questions or concerns related
to transition.
This tool has been selected by SHC as a model transition
screening tool. |
Transition Screening Tool
[word]
[pdf] |
Transition Worksheet
Shriners Hospital for Children - St. LouisThis one page
worksheet can be used by providers in their encounters
with transitioning youth. Domains queried include: living
arrangements, transportation, medical resources, insurance,
employment, leisure and community participation, education
and advocacy/legal issues. |
Transition Worksheet
[word]
[pdf] |
| Screening: Transition-focused
including burn issues |
Transition Screening
Shriners Hospitals for Children -Cincinnati Burns HospitalThis
screening tool is designed to identify the transition-related
needs and concerns of youth who have sustained a burn
injury. It is provided as an example of how a transition
screening tool can be designed for youth with a specific
health condition. |
Transitions Screening
[word]
[pdf] |
| Screening: Health care assess
and issues |
HRTW-Ohio
Health Care Access and Issues
List of questions for youth to consider about their health
and health care |
Health Care Screening:
Adolescents & Young Adults
[word]
[pdf] |
| Screening: Adult Health
Promotion |
Put Prevention Into Practice (PPIP)
program from the Agency for Healthcare Research and Quality:
Women: Stay Healthy at Any Age Checklist for Your Next
Checkup (Also in Spanish)
Men: Stay Healthy at Any Age Checklist for Your Next Checkup
(Also in Spanish) |
www.ahrq.gov/ppip/
healthywom.htm
www.ahrq.gov/ppip/
healthymen.htm
www.ahrq.gov
www.ahrq.gov/clinic/
ppipix.htm |
