Free checklists and forms to help you organize your FQHC healthcare.
Note: These guides are currently available as described below. Downloadable PDF versions are in development. In the meantime, use the descriptions to create your own version or ask your FQHC if they have printed materials available.
A one-page checklist of what to bring, questions to ask, and information to have ready before your first FQHC appointment.
Track all current medications, dosages, schedules, prescribing provider, and pharmacy. Bring to every appointment.
Record visit dates, providers seen, diagnoses, medications changed, and follow-up instructions. Useful for tracking care over time.
A one-page form to summarize past diagnoses, surgeries, hospitalizations, family history, and allergies. Useful when switching providers.
A blank template to write down your questions before each appointment so you don't forget them in the moment.
A simple template for self-reporting household income when you don't have formal documentation — accepted by most FQHCs for the sliding fee scale.
Notes on what authorizations are needed when accompanying a family member or dependent to their FQHC appointment.
Track specialist referrals — who referred you, the specialist's contact info, appointment date, and what to bring.