Downloadable Online Forms

Online Forms Guide

Medical Evaluation Forms, Assessment Tools, and Educational Materials

PCNA's Online Forms Guide includes downloadable PDF templates of clinical forms and patient handouts that you can use in your CVD risk reduction practice. These forms can be integrated into patient medical records; they include patient assessment forms, contracts, flow charts, follow-up plans & tools, patient-education materials, and a list of online resources.

THIS IS A MEMBER-ONLY TOOL!

MEMBERS: Log-in to your PCNA Portal above OR click "Your Account" if currently logged-in to access the "Forms Guide" tab in your PCNA Portal

TABLE OF CONTENTS:

I. Patient Assessment
II. Flow Charts
III. Contracts and Self-Monitoring Logs
IV. Drug Information Sheets for Patients
  Anti-Hypertension Agents
  Anti-Anginal Medications
  Anti-Platelet/Anti-Coagulation
  Lipid Lowering Agents
  Diabetic-Oral Anti-Hyperglycemia Agents
  Smoking Cessation Aids
  Weight Loss Aids
V. Evaluation Tools
VI. Peripheral Arterial Disease
VII. Diabetes
VIII. Nutrition
IX. Stress Management
X. Follow-Up Tools
XI. Patient Education
XII. Exercise
XIII. Information on Smoking Cessation
XIV. Medication Adherence
XV. Hypertension - Ambulatory and Home Blood Pressure Monitoring
XVI. Models of Behavior
XVII. Searching the Internet for Cardiovascular Resources
XVIII. Lipid Reference Values


AUDIENCE:

The audience for this program will be primarily nurses and nurse practitioners specializing in cardiovascular risk assessment, risk reduction, and disease management.

EDITORS:
Janet Long, MSN, ANCP, CLS, FAHA, FPCNA
Nurse Practitioner, Co-Director Cardiovascular Risk Reduction Program
Rhode Island Cardiology Center
Providence, RI

Cindy Lamendola, MSN, ANP-BC, FAHA, FPCNA
Clinical Research Coordinator
Stanford University School of Medicine
Stanford University Medical Center
Stanford, CA

Jane Nelson Worel, MSN, APRN-BC, APNP, FAACVPR, FPCNA
Phases, Primary healthCare for Women
Madison, WI

REVIEWERS:
Jane Linderbaum, NP
Family Nurse Practitioner
Mayo Clinic
Rochester, MN

Kenneth A. Kellick, PharmD
Clinical Pharmacy Coordinator
VA Western NY Healthcare System
Buffalo, NY

Nancy Houston Miller, RN, BSN, FAHA, FPCNA
Associate Director
Stanford Cardiac Rehabilitation Program
Palo Alto, CA

GRANTOR:
This tool is supported by an educational grant from Merck/Schering-Plough and by a grant by the Hartford Institute for Geriatric Nursing at the New York University College of Nursing as part of an initiative called REASN, (Resourcefully Enhancing Aging in Specialty Nursing). The REASN initiative is funded with a $2.3 million dollar grant from The Atlantic Philanthropies (USA) Inc.

COST:
This online educational activity is offered free of charge.

ACCESS INSTRUCTIONS:
To access the Table of Contents, you will need to register or log in using the link at the top of this page. Once you are logged in, you can view the Table of Contents and select individual forms or multiple forms by section. Many of these forms may be customized to include your organization's name, telephone number, and other important information in the editable fields as indicated. Once downloaded, these forms may be printed for one-time or multiple-time use.

PCNA hopes that these forms will enhance your practice by allowing you to provide the best care to your patients by reducing their cardiovascular risk factors and help them reach treatment goals.

DISCLAIMER:
Please be aware that these forms include a sample of current clinical guidelines. However, clinical guidelines (federal, state, local, or those issued by clinical organizations) change over time, so the reader should remember to investigate any recent legal or clinical developments.

Section 4 of these Forms contains lists and information on commonly used medications. These lists and the information about the medications are not meant to be exhaustive. Consult complete guidelines for a more comprehensive review of indications and clinical follow-up recommendations. All patients should be evaluated based on their state of health, co-morbidities, and other criteria that would guide choices of medical therapy.