Health and Wellness

Frequently Requested Forms & Documents

 

In this section, you will find documents used for the Job Corps Health and Wellness program.

• Administrative Forms
• Desk Reference Guides
• Federal Directives
  • Information Notices
• PRH Change Notices
• Program Instruction Notices
• General Health
• Job Corps Data Center Notices
• Health Record
• Newsletters
• Program Compliance Assessments
• Standard Operating Procedures (SOP) Templates
• Technical Assistance Guides

Administrative Forms

• Job Corps Research Study Submission Form — Part 1: Submission of Concept for Initial Approval
• Job Corps Health Services Utilization Statistics
• Health and Wellness Student Satisfaction Survey — February 2013
• Student Transfer Summary Checklist — June 2019
• Sample Medical Separation with Reinstatement (MSWR) Form — November 2019

Desk Reference Guides

• Desk Reference Suite — Binder spine
• Desk Reference Guide Covers
• Health & Wellness Manager (HWM) Desk Reference Guide (PDF file) — July 2015
• Center Physician Desk Reference Guide (PDF file) — May 2019
• Center Mental Health Consultant (CMHC) Desk Reference Guide​ (PDF file) — October 2019
• Center Dentist Reference Guide (PDF file) — February 2019
• TEAP Specialist Desk Reference Guide (PDF file) — January 2019

General Health

• Student at a Glance (writable) and Example of Student at a Glance
• SPAMIS Medical Separation Codes for Job Corps Centers — July 2018
• Suggested Medical Equipment and Supplies List — December 2015 
• Suggested Dental Equipment List and Specifications — September 2013
• Job Corps List of Non-Prescription Medications — August 2019

Job Corps Data Center Notices

• JCDC Notice 17-189 National Health & Disability Conferences Memo
  Attachment: Memo
  Date: April 17, 2018
• JCDC Notice 17-115 Health Leave Policy Delay
  Release Date: December 28, 2017
• JCDC Notice 16-093 (Addendum) Breathalyzers Delivered to Job Corps Centers
  Training Video: https://www.youtube.com/watch?v=NEHoUpa01E0
  Release Date: December 16, 2016

Health Record

Medical

• Job Corps Health History Form Instructions
• Job Corps Health History Form
• Health History Form with no header
• Job Corps Physical Examination Form — June 2013
• ETA 6-53 Job Corps Health Questionnaire, Instructions, and Documentation Guidance
• SF-600 Chronological Record of Medical Care
• Job Corps Immunization Forms (Job Corps Immunization Record, PPD Testing, Isoniazid (INH) Chemoprophylaxis) — April 2015 
• Social Intake Form — October 2012
• Student Transfer Summary Checklist — June 2019
• On Center Lab Results - Point of Care Testing — December 2013

Dental

• Job Corps Oral Examination Record Form — June 2013
• Job Corps Oral Examination Record Instructions — June 2013

Charting

• PI 14-33 Authorization to Release Health-care Information and Attachment 14-33a — June 9, 2015
• Quality Assurance Health Record Audit Form — June 2019
• Essentials of Job Corps Health and Wellness Charting (Medical, Oral Health, Mental Health and TEAP Charting) — August 2017 

Newsletters

Job Corps Health and Wellness

• Job Corps Health and Wellness Solutions — Winter 2020
• Job Corps Health and Wellness Solutions — Fall 2019
• Job Corps Health and Wellness Solutions — Summer 2019
• Job Corps Health and Wellness Solutions — Spring 2019
• Job Corps Health and Wellness Solutions — Fall 2018
• Job Corps Health and Wellness Solutions — Summer 2018
• Job Corps Health and Wellness Solutions — Spring 2018
• Job Corps Health and Wellness Solutions — Winter 2017/2018
• Job Corps Health and Wellness Solutions — Fall 2017
• Job Corps Health and Wellness Solutions — Summer 2017
• Job Corps Health and Wellness Solutions — Spring 2017
• Job Corps Health and Wellness Solutions — Winter 2016
• Job Corps Health and Wellness Solutions — Fall 2016
• Job Corps Health and Wellness Solutions — Summer 2016
• Job Corps Health and Wellness Solutions — Spring 2016
• Job Corps Health and Wellness Solutions — Winter 2015-2016
• Job Corps Health and Wellness Solutions — Fall 2015
• Job Corps Health and Wellness Solutions — Summer 2015
• Job Corps Health and Wellness Solutions — Spring 2015
• Job Corps Health and Wellness Solutions​ — Winter 2014 
• Job Corps Health and Wellness Solutions​​ — Fall 2014 
• Job Corps Health and Wellness Solutions​ — Summer 2014 
• Job Corps Health and Wellness Solutions — Winter 2014
• Job Corps Health and Wellness Solutions — Fall 2013
• Job Corps Health and Wellness Solutions — Summer 2013
• Job Corps Health and Wellness Solutions — Spring 2013
• Job Corps Health and Wellness Solutions — Winter 2013
• Job Corps Health and Wellness Solutions — Fall 2012
• Job Corps Health and Wellness Solutions — Spring 2012
• Job Corps Health and Wellness Solutions — Summer 2011
• Job Corps Health and Wellness Solutions — Spring 2011
• Job Corps Health and Wellness Solutions — Winter 2011
• Job Corps Health and Wellness Focus — Fall 2010
• Job Corps Health and Wellness Solutions — March 31, 2010

Health & Wellness Program Compliance Assessments

• Center Dentist — October 2019
• Center Mental Health Consultant — February 2019
• Center Physician — July 2016
• Family Planning Coordinator — June 2016
• Health and Wellness Manager (Medical Separations) — October 2016
• TEAP Specialist — August 2018
• TUPP Coordinator — January 2018
• Healthy Eating and Active Lifestyles (HEALs) Coordinator — June 2016
• SART Coordinator — June 2016
• Nurse Practitioner/Physician Assistant — June 2016
• Medical Management — October 2019

• Health and Wellness PCA Tool: Behavioral Assessor Packet — October 2019
• Health and Wellness PCA Tool: Medical Assessor Packet — February 2020
• Health and Wellness Compliance Assessment Action Items — April 2017
• Health and Wellness Program Assessment Staff and Student Interview Schedule — August 2018
• Health and Wellness Documents and Materials Checklist  — August 2018
• Health and Wellness PCA Student Focus Group Questions — October 2019
• MSWR Calculator and Decoder — October 2019
• Health Utilization Statistics/HMIS Tool — February 2020
• Staff Training Records Tool — August 2018
• SOPs and COPs Tool — August 2018
• Professional Credentials Review — August 2018

Standard Operating Procedures (SOP) Templates

• Health and Wellness Center Staffing  (also available in MS Word format)
• Prescribed Non-controlled Medications (MS Word format)
• Prescribed Controlled Substances (MS Word format)
• Over-the-Counter (OTC) Medications (also available in MS Word format)

Technical Assistance Guides (TAGs)

Centers should maintain a copy of each Technical Assistance Guide (TAG) on file for reference.

• ​Family Planning TAG
  Release Date: September 2015
  Versions: PDF format​ or online
• Health Care Guidelines and Written Instructions
  Release Date: September 2015
  Versions: PDF format​ or online​ 
• Immunization Guide TAG
  Release Date: April 2015
  Versions: PDF format or online
• Mental Health Disabilities TAG
  Release Date: August 2019
  Versions: PDF format or online
• Sexual Assault Prevention and Response TAG
  Release Date: September 2015
  Versions: PDF format or online ​

Return to top​