Forms and Handouts

The forms developed for the intervention were based on interviews from nursing staff and prescribers. Some facilities then requested specific modifications to core components of the forms, reflecting the individual work system at each skilled nursing facility. These modifications range from minor additions for tracking processes to incorporating sections of the form in electronic health records. 

Below are comprehensive versions of the forms. Please contact your facility administrator if your facility has modified versions of the forms. Please also note, these forms are only for use by skilled nursing facilities participating in the OASIS Collaborative.

Prescriber Tools

Change in Condition Form: This form should be used when a patient experiences a questionable change in condition and you consider notifying the patient’s primary care prescriber to alert them of this change in condition.

Antibiotic Review Form: This forms should be used after a patient has been prescribed an antibiotic.