Below are several downloadable forms and questionnaires required by clinics for delivering various treatments and services to employees of Health Resources clients. If you are unable to locate the desired form, please contact us at 1-800-350-4511.
Occupational Health Downloads Audiometric History and Result Form Ergonomic and Musculoskeletal Questionnaire General Medical Questionnaire (non-exposed employees) General Medical Questionnaire (Exposed employees, Federally mandated) Hepatitis A Vaccine Consent Hepatitis B Vaccine Consent Medical Information Release OSHA Respirator Fitness Medical Evaluation Questionnaire Periodic Medical Questionnaire Physical Examination Form Spirometry Form Tetanus and Diphtheria (TD) Vaccine Consent Kit Requests Order Drug Screen Kit Order Blood Test Kit Note: only requests from clinics registered with Health Resources can be fulfilled.
Several forms and documents are also available for download by Health Resources’ current and prospective EAP clinical affiliates. Contact us at 1-800-350-4511 if you do not see the form you require.
Current Affiliate Downloads Statement of Understanding EAP Assessment Form Staff Progress Notes EAP Closure Form Provider Bill for Services Release of Information Consent Affiliate Paperwork Formal Paperwork Formal Referral Paperwork SAP Paperwork (Substance Abuse Professional Form) Prospective Affiliate Downloads Affiliate Application Contract Individual Template Policies and Procedures Contract Group Template