Forms & Templates
The following documents address program related activities, processes, and guidelines.
General Nursing Forms
The attached forms include note templates, lab test logs, standardized operating procedures, and reporting forms for the Harm Reduction Health Program.
- 2018 Naloxone Program Intake Form Short.pdf
- 2018 Nasal Narcan Administration Guide.pdf
- 2018 Overdose Emergency Procedures.pdf
- Chart Checklist
- Client Contact Sheet 2.xlsx
- Client Assessment Form.pdf
- Consentform8.15.13.doc
- Demographic & History 2.11.doc
- Hep C Test Log
- Medication Administration Record.xlsx
- Naloxone Physician Chart Review 2017.docx
- Naloxone Physician Review 2017.pdf
- Nurse Preceptor Checklist
- Nursing Progress Note Draft 2.10.doc
- Rapid HIV Temperature Log (Alere Determine & INSTI)
- Rapid HIV Test Log (Alere Determine)
- Rapid HIV Test Log (INSTI)
- Records Release Authorization.pdf
- Referral Form 2.16.doc
- Supply List
- Vaccine Temperature Log.pdf
- Wound Care Nursing Notes
- Wound Care Nursing Notes – Foot
- Wound Care Nursing Notes – Hand
STI Testing & Treatment
The below resources include STI case reporting forms, STI treatment guidelines, and treatment resources.
- 2021 STD Treatment Guidelines Pocket Guide
- 2021 STD Treatment Guidelines Wall Chart
- New Jersey PrEP Access List
- STD medications order form 2018 update.docx
- STD reporting requirements in NJ
- STD reporting tracking document
- STD-11a – Confidential Syphilis Case Report Form
- STD-11b – Confidential Gonorrhea Case Report Form
- STD-11c – Confidential Chlamydia Case Report Form
Standing Orders
The following standing orders represent clinical services the HRH nurse provides at the harm reduction site. All standing orders should be signed yearly by your site’s medical director.
- Administering Hep A and B vaccine_April2018.docx
- Administration and Interpretation of TB Skin Tests_April2018.docx
- Anal Swab GC/C
- Blood Pressure Monitoring Standing Order.doc
- Conducting Pregnancy Testing_April2018.docx
- gardasil_April2018.pdf
- Glucose monitoring standing order.doc
- HCV rapid testing_April2018.doc
- Hep A_April2018.pdf
- Hepatitis B and C testing_April2018.docx
- Hep B_April2018.pdf
- Medical management of vaccine reactions_adults_April2018.pdf
- Oral GC/C
- Revised Administering Naloxone_April23_2018.docx
- Revised Administering Naloxone (Blanket order, September 2022)
- Scabies Treatment Standing order.docx
- STI-Guidelines-2021.pdf
- Syphilis Standing Order
- Trichomonas Standing Order
- Tdap_April2018.pdf
- Urine GC/C
- Wound Assessment & Care