1. Fax Cover Sheet
![Fax Cover Sheet. Select [D] Text Description below for details.](/sites/default/files/wysiwyg/patient-safety/settings/long-term-care/fallspx/fallpx-faxcover.jpg)
2. Falls Assessment Report
![Falls Assessment Report. Select [D] Text Description below for details.](/sites/default/files/wysiwyg/patient-safety/settings/long-term-care/fallspx/fallpx-assesstreport.jpg)
3. Fax Back Orders
![Fax Back Orders. Select [D] Text Description below for details.](/sites/default/files/wysiwyg/patient-safety/settings/long-term-care/fallspx/fallpx-faxbackcover.jpg)
[D] Select for Text Description for all images.
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The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Appendix B10: Primary Care Provider Fax Report and Orders
Table of Contents
- The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
- Chapter 1. Introduction and Program Overview
- Chapter 2. Fall Response
- Chapter 3. Data Collection and Analysis Using TRIPS
- Chapter 4. Long Term Management
- Chapter 5. Information and Training for Staff, Primary Care Providers, and Residents and their Families
- Chapter 6. Environment and Equipment Safety
- Appendix A. References and Equipment Sources
- Appendix B. Forms and Training Materials (Appendix Contents)
- Appendix C. Case Study and Program Examples
- Appendix D. Falls Engineer Instructions
Publication: None
Page last reviewed February 2023
Page originally created February 2010
Internet Citation: Appendix B10: Primary Care Provider Fax Report and Orders. Content last reviewed February 2023. Agency for Healthcare Research and Quality, Rockville, MD.
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