Sexually Transmitted Disease Standard of Practice Evaluation Form
Circle appropriate period
Documentation reflects consideration of client’s needs in determining interventions and/or on-going revisions of the plan of care (p. C35).
Documents client understands the disease process and prevention of transmission
Determines and documents the effectiveness of interventions (p. C35).
Verifies with appropriate medical provider or per client’s self report that treatment was obtained and taken.
Initiates action for non-adherent client/contacts (p. C35).
Follow up with non-adherent client/contacts (p. C35).
Dispositions and closes case in Casewatch® within 14 days of receipt of referral or within timeframe agreed upon with PHNS (p. C35).
Follows up on referrals as reported by client, if more than one client contact is needed (p. C34).
© 2007 LAC DPH-Public Health Nursing