Questions to consider before ordering a Form or Education Materials
from Printing & Copying Services
1. Is this a form that already exists in the Medical Record?
• If Yes, any changes must be approved by Clinical Forms Committee (Call 924-2196).For more information about forms approval or approved abbreviations see:
2. Is this a form that is to become part of the Patient's Permanent Medical Record?
• If Yes, has the form been approved by the Clinical Forms Committee?
• If Yes, What Medical Record Category has been given by the Committee?
Number and Category: __________________
• If No or questions, direct requestor to Clinical Forms Committee, 924-2196
3. Is this material to be used for Discharge Instructions?
• If Yes, will the instructions be customized for the patient?
• If Yes, these will be on a NCR UVa Form with Barcode and included in the chart.
• If No, it will be put on the UVa Pt Ed Template, not included in the chart and will need a number assigned by Office of Patient and Family Education. Direct requestor to Cindy Westley, cjw2s@eduvirginia. or 924-5724.
4. Is this material to be used for Patient Education?
• If Yes, and is a new or revised piece, has the Office of Patient and Family Education given an identifying number? Please note: any identifying numbers on materials before January 2006 is out of date - new numbers start with a category number and no longer have PEME?
• If No or questions, direct requestor to Cindy Westley, email@example.com or 924-5724
5. Is this material a translation to another language?
• If Yes, has it been approved by Language Assistance Services?
• Only English materials will be put into the patient's medical record. Forms must be formatted based on the Formatting Guidelines below.**
• If No or questions, direct requestor to Sally LeBeau, firstname.lastname@example.org or 924-9244
6. Does the material have any other logo/graphic element besides or in addition to the official UVaHS logo (Note: Templates exist for "Fact Sheet", "Pt Info/Handbook" and "Pt Info Shell". If there is any question about the use of the material contact Reecye Modny. )
• If Yes, has Marketing approved?
• If No or questions, direct requestor to Reecye Modny, email@example.com or 924-0366