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 and Notices
  • Information Notices
• PRH Change Notices
• Program Instruction Notices
• Job Corps Data Center Notices
• General Health
• 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 2020
• Sample Medical Separation with Reinstatement (MSWR) Form — November 2019
  Formulario de Separación Médica Con Reinstalación (Spanish) NEW
• Student Death Checklist — June 2020 

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 (includes Aerosol Containment Additions) — July 2020 
• Job Corps List of Non-Prescription Medications — August 2019

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 — September 2021  NEW
  Job Corps Immunization Record, Tuberculin Testing, Chemoprophylaxis for Latent Tuberculosis
• Social Intake Form — October 2012
• Student Transfer Summary Checklist — June 2019
• On Center Lab Results - Point of Care Testing — December 2013
• Off-Center Appointment Verification and Feedback Form — March 2020

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​ — Summer 2021
  
• Job Corps Health and Wellness Solutions — Spring 2021
• Job Corps Health and Wellness Solutions — Winter 2021
• Job Corps Health and Wellness Solutions — Fall 2020
• Job Corps Health and Wellness Solutions — Summer 2020
• Job Corps Health and Wellness Solutions — Spring 2020
• 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

Standard Operating Procedures (SOP) Templates

• Health and Wellness Center Staffing  (also available in MS Word format)
  Click here for Sample HWC Staffing SOP​ (includes new Health & Wellness Director title)
• 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: July 2020
  Versions: PDF format​ or online
• Health Care Guidelines and Written Instructions
  Release Date: August 2021
  Versions: PDF format​ or online​ 
• Immunization Guide TAG   NEW
  Release Date: September 2021
  Versions: PDF format or online
• Mental Health Disabilities TAG
  Release Date: July 2021
  Versions: PDF format or online
• Sexual Assault Prevention and Response TAG
  Release Date: August 2021
  Versions: PDF format or online ​

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