| Core Value Nomination | | | | |
Department: Medical Center Last Updated: 08/02/2007 Contact: Sharon Lanham Brief Summary: Form to be used by staff to nominate employees for Core Value (Sense of Urgency, Teamwork, Accountability, Innovation and Respect) recognition on a monthly basis. |
| Donor Assessment on Day of Marrow Collection Procedure | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form to document the assessment of bone marrow donors on the day of bone marrow collection. |
| Donor Lymphocyte Infusion: Donor Assessment/Apheresis Procedure | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form to document the assessment of DLI donor prior to and during a donation of stem cells via apheresis. |
| G-CSF Mobilized PBSC Days Five and Six Donor Assessment/Apheresis Procedure | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form to document the assessment of a stem cell donor prior to and during the collection of stem cells via aphresis. |
| G-CSF Mobilized PBSC Days One, Two Three and Four Donor Assessment | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form to document assessments of donors who are receiving G-CSF in preparation for a stem cell donation. |
| Hospital Forms - Employee Exit Checklist | | | | |
Department: Medical Center Last Updated: 04/29/2004 Contact: Not Available Brief Summary: Not Available |
| Hospital Forms - Hospital CSF #2 | | | | |
Department: Medical Center Last Updated: 04/29/2004 Contact: Not Available Brief Summary: Not Available |
| Hospital Forms - Hospital Employee of the Month Form | | | | |
Department: Medical Center Last Updated: 08/02/2007 Contact: Not Available Brief Summary: Not Available |
| Hospital Forms - Hospital Equipment Move/Transfer Form | | | | |
Department: Medical Center Last Updated: 07/27/2006 Contact: Nancy Hammond, 3-8906 Brief Summary: Not Available |
| Hospital Forms - Hospital Equipment Surplus Form | | | | |
Department: Medical Center Last Updated: 08/23/2006 Contact: Nancy Hammond, 3-8906 Brief Summary: Not Available |
| Hospital Forms - Hospital Exit Interview Survey | | | | |
Department: Medical Center Last Updated: 04/29/2004 Contact: Not Available Brief Summary: Not Available |
| Hospital Forms - Hospital H968 | | | | |
Department: Medical Center Last Updated: 04/29/2004 Contact: Not Available Brief Summary: Not Available |
| Hospital Forms - Hospital PAR | | | | |
Department: Medical Center Last Updated: 04/29/2004 Contact: Not Available Brief Summary: Not Available |
| Information Technology Services Security Forms Page | | | | |
Department: Medical Center Last Updated: 08/10/2009 Contact: HealthCare Information Security 257-5112 Brief Summary: Link to Information Security's forms page. |
| Informed Consent for Bone Marrow Donation | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A consent form for patients who will be donating bone marrow. |
| Informed Consent for the Collection of G-CSF Mobilized Peripheral Blood Stem Cells (PBSC) via Apheresis. | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A consent form for persons donating peripheral blood stem cells. |
| Informed Consent for the Priming, Mobilization, and Collection of Peripheral Blood Stem Cells for Use in an Autologous Stem Cell Transplant | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A consent form for persons donating stem cells for themselves. |
| Informed Consent for Therapeutic Cells, T-Cells for Donor Leukocyte Infusion (DLI) | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A consent form for persons who are donating t-cells for use in an allogenic transplant. |
| Omitted Donor Follow-Up | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form to document the reason for a failure to conduct a stem cell donor follow-up assessment. |
| Ongoing Competency Assessment 2005 | | | | |
Department: Medical Center Last Updated: 11/23/2005 Contact: Jane Howell, jthowe01@email.uky.edu or 7-5328, Performance Improvement and Patient Safety Brief Summary: Checklist for preparing individual personnel files on competency for JCAHO visit in 2006 and years thereafter. |
| Personnel File Checklist | | | | |
Department: Medical Center Last Updated: 10/10/2008 Contact: Louise White, Quality and Safety, 323-8062, lswhit2@email.uky.edu Brief Summary: Personnel file checklist to meet Joint Commission requirements. |
| Stem Cell Donor Follow-Up | | | | |
Department: Medical Center Last Updated: 07/06/2009 Contact: Mary Gray, Bone Marrow Transplant, 859-323-6770, maryegray@uky.edu Brief Summary: A form for documenting follow-up of persons who donated stem cells. |
