The TSWF Nursing Services AIM form is intended to be used by nurses and clinical support staff in adult PCMH clinics. The form is not designed for use in pediatric and non-PCMH immunization clinics.

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Nursing Services Recent Changes

  • 3 changes for Jan-Apr 2019 update

Immunizations Tab

  • Removed “3. VIS [] date given to patient” from PPD Placement ribbon under A/P documentation

Procedures 1 tab

  • Updated Throat Culture pre-positioned text to: Throat Swab Obtained X 2 for Rapid Strep and Routine Culture (if indicated [i.e. RADT result negative]) on Respiratory ribbon

Procedures 2 tab

  • Dysuria Content updated on Urinary Tract infection/dysuria ribbon

Jan-Apr Mid-Cycle Changes

  • Revision 1 – Split the Urinary Tract Infection / Dysuria box into two sections to allow more room for documenting.
  • Revision 2 – Changed Depo clue to read “DEPO Window= target 13 weeks (91 days) with range 11-15 weeks (77 days to 105 days)


  • Created June 2014
  • Standardize documentation
  • Intended use in adult PCMH clinics

The TSWF Nursing Services form was created in early 2014 and went live on the AHLTA Enterprise in June 2014. It was created to standardize the nursing services documentation of administered immunizations, medications, nursing procedures, and patient education & counseling performed at the point-of-service. The form’s intended use is acute, routine, or other scheduled patient visits in adult PCMH clinics.

Form Lead

TSWF-Nursing Services Form Lead
Scot Ario

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