Agreements with domestic staff 2026

1. Click ‘Get Form’ to open the agreement in the editor.
2. Begin by entering the date and patient ID at the top of the form. This information is crucial for tracking and reference.
3. Fill in the patient’s name and provider’s name in the designated fields to ensure proper identification.
4. Indicate whether the patient is pregnant by selecting 'Yes' or 'No'. This helps tailor further assessments.
5. In the DV Screen section, mark 'DV+' for positive screening or 'DV?' if suspected. This is vital for determining next steps.
6. Document examination findings in the provided space, ensuring all relevant details are captured for accurate records.
7. Assess patient safety by answering yes or no to each question regarding potential risks and concerns about their situation.
8. Complete referral sections as necessary, detailing any legal, shelter, or other referrals made during your assessment.
9. Finally, address reporting requirements by indicating if any reports were made to law enforcement or protective services.

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