DIRV Articles and Forms
Here is a listing of our important articles and forms. Click this link to download specific articles and forms. Click Here.
Current Articles and Forms
All of our digital articles and forms are available at: Click Here
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Fire safety in your RV is important because there are so many ways a fire can occur. Minimizing RV fire risks should be a top priority. This is more than just making sure that fire detectors and extinguishers are operating as designed. Fire safety document plus fire safety checklist.
New Patient Form
(7 Page PDF)
Patient information, emergency contact, employer, insurance, current medical problems, obstetric and gynecological history, surgical history, allergies, medications, past medical history, family history, education; tobacco, alcohol, caffeine, drug use; financial policy and authorizations, consent to contact, notice of privacy practices, patient communication consent, disclosure to family members.
Medical History Short Form
(1 Page PDF)
A form with medical history, surgical history, hospitalizations, family history, social history, medications, allergies, immunizations.
Medical History Long Form
(4 Page PDF)
A form with medical history, ob/gyn history, surgical history, hospitalizations, family history, social history (alcohol, tobacco, etc), medications, allergies, immunizations, health maintenance and screening tests, review of systems.
RV Emergency Form
(1 Page PDF)
Don't Panic, You Now Have the Important Information at Your Fingertips! This form may be the most important form in your RV. It contains vital information needed in event of an emergency.
Authorization For Release of Health Information Form
(2 Page PDF) and (5 Page PDF)
A medical record release authorization. This form is to obtain a copy of your medical record or to have a copy sent to your physician or the person of your choice.
New Patient Registration Form
(1 Page PDF)
Patient information, name, address, date of birth, emergency contact, pharmacy, marital status, employer, gender, etc.
New Patient Medical Forms, Medical History and Contact Information
(47Page PDF)
Medical Contact Information Form
Medical contact form contains name, address, phone information of physicians, pharmacies, hospitals and clinics and emergency contacts.
Medical Demographics and History Form
Information on patient, guarantor, pharmacy, insurance, surgical history, past medical history, family history, education, use of tobacco, alcohol, caffeine, drugs; obstetric/gynecological history, consent to contact, communication preferences, disclosure to family members, privacy practices.
All of the new patient forms are similar with some small changes
Dental Forms, Consent Forms, Demographic Forms and Pediatric Forms (14 Page PDF)
New Patient Dental Form
Patient information, guarantor, emergency contact, payment information, dental history, medical history, illnesses and symptoms, allergies, agreement.
Communication Consent Form
A form with notice of privacy practices, communication consent, disclosure to family members.
Patient Demographics Form
Patient information, name, address, birthday, gender, marital status, employer name, insurance information, insurance, HIPAA acknowledgment and consent form.
New Pediatric Patient Form - 6 years and up
Pediatric form for children 6 years of age and up. Patient information, birth history, medical history, family medical history, authorization for consent to medical care and treatment.
New Pediatric Patient Form - Newborn to 6 years
Pediatric form for children from newborn to 6 years of age. Patient information, birth history, medical history, family medical history, social history, authorization for consent to medical care and treatment.
Blood Sugar and Vital Signs Record, Medical and Systems Review (2 Page PDF)
This form expands on the blood sugar form with the addition of blood pressure, pulse, respirations, and temperature.
Medical and Systems Review
This form contains extensive information. Completing this form prior to your medical visit will eliminate many questions you are asked. This form contains name, date of birth, past history, pregnancy history, immunization history, previous hospitalizations, surgery history, family history, social history, occupation, education, marital status, habits, medications, allergies, and a review of systems which contains many of the questions your doctor would ask.
More Information Coming Soon
New articles and forms will be listed here when release.
More Information Coming
New articles and forms will be listed here when release.
More Information Coming
New articles and forms will be listed here when release.
PENDING ARTICLES AND FORMS
RV Injuries
Dangers of the Dump Zone
Old deteriorating RVs
RV Slides Injuries
Snakebites, Bug Bites, Ant Bites
Allergic Reactions
Lightning Strikes
Infections
Pulse Oximeter Use
Oxygen and Oxygen Tanks
First Aid Kit Contents
The Black Tank - Sewage Drainage and Infections
Battery Safety
Exercise
Goal Zero Use
CPAP Machine
Water Filters
Air Quality and Filters
Fever Chart
Pet food safety
Child Proofing your RV
Cold and Hot Weather Illnesses
Medications
Lakewater Health Risks
Tourniquets Uses
Flammable Household Products