Clinical Forms – N to Z

CTRL + F - SEARCH TIP

Due to the large list of forms below, using the CTRL+F (Find) function will generate a search bar at the top right corner of the screen where you can begin typing key words.  Where there are multiple documents with the same key word(s), use the arrows in the search box to view each document. 

N

Newborn Care Record - Midwifery (SHA 0295)
(PDF 159.28 KB)
Published April 23, 2025
Newborn Exam - Midwifery (SHA 0299)
(PDF 148.8 KB)
Published April 23, 2025
Newborn Hearing Screening Requisition (SHA 0250)
(PDF 713 KB)
Published January 6, 2023
Nirsevimab Injection Record (SHA 0619)
(PDF 146.79 KB)
Published November 12, 2025
Nurse Practitioner Orientation Checklist - Continuing Care (SHA 0497)
(PDF 278.03 KB)
Published November 22, 2024
Nursing Assessment - Kidney Stone Prevention Clinic (SHA 0438)
(PDF 627.58 KB)
Published October 17, 2024
Nutrition - Home Nutrition Plan - NICU (SHA 0496)
(PDF 115.19 KB)
Published November 14, 2024
Nutrition Assessment - Pediatric Outpatient Initial (SHA 0495)
(PDF 146.48 KB)
Published November 14, 2024
Nutrition Assessment and Care Plan - Outpatient Adult (SHA 0494)
(PDF 477.51 KB)
Published November 14, 2024
Nutrition Assessment Record - LTC (SHA 0492)
(PDF 646.46 KB)
Published November 12, 2024
Nutrition Progress Note - Dietitian – Downtime (SHA 0265)
(PDF 119.54 KB)
Published November 1, 2024
Nutrition Progress Note – Outpatient Pediatric (SHA 0493)
(PDF 482.59 KB)
Published November 14, 2024
​Nasal High Air Flow Monitoring Record (SHA 0129)
(PDF 315.41 KB)
Published April 22, 2022

O

Ocular Donor Assessment Form (SHA 0427)
(PDF 605.72 KB)
Published July 11, 2024
OOH Labour Assessment - Midwifery (SHA 0296)
(PDF 136.56 KB)
Published April 23, 2025
OOH Labour/Birth Summary - Midwifery (SHA 0298)
(PDF 149.13 KB)
Published April 23, 2025
Opioid Agonist Therapy - Clinical Note (SHA 0254)
(PDF 487.45 KB)
Published January 18, 2023
Opioid Agonist Therapy - Initial Visit (SHA 0253)
(PDF 489.31 KB)
Published January 18, 2023
Oral Health Program Assessment Note (SHA 0549)
(PDF 124.8 KB)
Published January 31, 2025
Oral Healthcare Team Inpatient Referral Form (SHA 0642)
(PDF 136.83 KB)
Published October 23, 2025
Outpatient Fall Risk Screening Form Single Screening (SHA 0662)
(PDF 229.15 KB)
Published March 10, 2026
Outpatient Hand Therapy Referral - Occupational Therapy (SHA 0527)
(PDF 164.58 KB)
Published January 14, 2025

P

Pain Assessment Documentation - Long Term Care/Home Care (SHA 0365)
(PDF 825.11 KB)
Published November 24, 2023
PAINAD - Pain Assessment IN Advanced Dementia (SHA 0231)
(PDF 696.78 KB)
Published August 24, 2022
Palliative Care Referral Form (SHA 0434)
(PDF 615.95 KB)
Published September 13, 2024
Palliative Performance Scale (SHA 0288)
(PDF 564.73 KB)
Published August 23, 2023
Paper Patient Safety Incident Report Form (SHA 0459)
(PDF 334.01 KB)
Published March 4, 2025
Patient Booking System - Intake Request (SHA 0396)
(PDF 589.12 KB)
Published March 6, 2024
Patient Intake Form - Kidney Health (SHA 0293)
(PDF 436.79 KB)
Published July 7, 2023
Patient Notification of Transfusion (SHA 0480)
(PDF 115.68 KB)
Published November 21, 2024
Pediatric Complex Care Community Referral (SHA 0515)
(PDF 129.78 KB)
Published December 18, 2024
Pediatric Consult Liaison Follow-Up (SHA 0655)
(PDF 110.73 KB)
Published December 9, 2025
Pediatric Consult Liaison Psychiatry Assessment Note (SHA 0654)
(PDF 152.41 KB)
Published December 9, 2025
Pediatric Early Warning System (PEWS) SBAR Tool (SHA 0648)
(PDF 239.41 KB)
Published November 12, 2025
Pediatric MD Admission Note (SHA 0651)
(PDF 157.99 KB)
Published November 14, 2025
Pediatric MD Discharge Summary (SHA 0653)
(PDF 176.23 KB)
Published November 14, 2025
Pediatric MD Transfer and/or Repatriation Note (SHA 0652)
(PDF 205.58 KB)
Published November 14, 2025
Pediatric Procedural Sedation Checklist and Record (SHA 0646)
(PDF 337 KB)
Published November 12, 2025
Pediatric Respiratory Assessment Measure (PRAM) (SHA 0641)
(PDF 232.42 KB)
Published December 3, 2025
Pediatric Vital Signs Record (SHA 0647)
(PDF 310.01 KB)
Published November 12, 2025
Pediatrics Complex Care - Consult Note (SHA 0593)
(PDF 136.36 KB)
Published June 19, 2025
Pediatrics Complex Care - Discharge Plan (SHA 0594)
(PDF 148.2 KB)
Published June 19, 2025
Pediatrics Complex Care - Medical Care Plan (SHA 0596)
(PDF 122.08 KB)
Published June 19, 2025
Pediatrics Complex Care – Progress Note (SHA 0595)
(PDF 121.11 KB)
Published June 19, 2025
Pelvic Floor Pathway Clinic Referral (SHA 0260)
(PDF 549.45 KB)
Published May 9, 2023
Pertussis Contact Instructions (SHA 0600)
(PDF 141.38 KB)
Published June 26, 2025
POISE/SUAP Program Consent for Release of Information (SHA 0626)
(PDF 131.12 KB)
Published October 22, 2025
Poison Centre Documentation Form (SHA 0411)
(PDF 511.37 KB)
Published April 30, 2024
Post Fall Record (SHA 0362)
(PDF 269.08 KB)
Published February 26, 2026
Postpartum Care Record - Midwifery (SHA 0301)
(PDF 153.17 KB)
Published April 23, 2025
Postpartum Hemorrhage Equipment List (SHA 0428)
(PDF 548.3 KB)
Published August 27, 2024
Practitioner Admission Note - Downtime (SHA 0402)
(PDF 510.22 KB)
Published July 15, 2024
Practitioner Consultation Request Note - Downtime (SHA 0404)
(PDF 495.6 KB)
Published July 15, 2024
Practitioner Procedure Note - Downtime (SHA 0408)
(PDF 488.59 KB)
Published July 15, 2024
Practitioner Progress Note – Brief - Downtime (SHA 0407)
(PDF 461.08 KB)
Published July 15, 2024
Private Care Provider Checklist (SHA 0457)
(PDF 464.41 KB)
Published October 1, 2024
Progress Note - Therapy Services - Psychology (SHA 0577)
(PDF 128.78 KB)
Published September 17, 2025
Provincial Prescription Form (SHA 0141)
(PDF 47.59 KB)
Published July 16, 2021
Public Health Nurse (PHN) Clinical Progression Assessment (SHA 0487)
(PDF 233.16 KB)
Published December 15, 2025
Public Health Nurse (PHN) Clinical Progression Guidelines (SHA 0486)
(PDF 480.68 KB)
Published December 19, 2024
Public Health Nurse (PHN) Orientation Schedule Template (SHA 0491)
(XLSX 30.9 KB)
Published December 19, 2024
PACSLAC-II Single Assessment (SHA 0224)
(PDF 746.91 KB)
Published June 6, 2022
Practitioner Discharge Summary Note - Downtime (SHA 0403)
(PDF 538.42 KB)
Published July 15, 2024
Practitioner Progress Note - Daily - Downtime (SHA 0406)
(PDF 464.45 KB)
Published July 15, 2024
Preschool Autism Pre-Assessment Form (SHA-0700)
(PDF 396.74 KB)
Published March 6, 2026
Pediatric Oncology Long-Term Follow-Up Care Plan (SHA 0689)
(PDF 169.65 KB)
Published February 12, 2026

Q

Quantitative Blood Loss Cumulative Total Record (SHA 0429)
(PDF 666.79 KB)
Published August 27, 2024

R

RAAM Suicide Risk Assessment (SHA 0060)
(PDF 209.58 KB)
Published June 18, 2020
Radiologist Sheet - Breast Health Centre - Regina (SHA 0680)
(PDF 130.66 KB)
Published January 27, 2026
Rapid Access Single Seizure (RASS) Clinic Referral Form (SHA 0484)
(PDF 149.09 KB)
Published October 30, 2024
Reconstitute Before Use Labels (SHA 0582)
(PDF 398.05 KB)
Published May 15, 2025
Recreation Therapy Assessment (SHA 0587)
(PDF 1.45 MB)
Published July 3, 2025
Recreation Therapy Discharge Summary (SHA 0588)
(PDF 237.39 KB)
Published July 3, 2025
Recreation Therapy Progress Note (SHA 0589)
(PDF 1.03 MB)
Published July 3, 2025
Red Blood Cell Exchange Run Sheet (SHA 0628)
(PDF 180.97 KB)
Published October 8, 2025
Renal Transplant Assessment Referral Form (SHA 0287)
(PDF 214.14 KB)
Published September 5, 2025
Request for Access to Medical Images (SHA 0145)
(PDF 322.28 KB)
Published September 14, 2021
Request for Private Care Provider Form (SHA 0456)
(PDF 604.6 KB)
Published October 1, 2024
Resident Belongings Form - Long Term Care (SHA 0525)
(PDF 151.87 KB)
Published January 13, 2025
Resident Move-In Checklist - Long Term Care (SHA 0482)
(PDF 282.44 KB)
Published October 16, 2025
Respiratory Support Referral (SHA 0556)
(PDF 197.45 KB)
Published March 25, 2026
Respiratory Therapy Assessment Flow Sheet – Neonate (SHA 0573)
(PDF 579.68 KB)
Published April 24, 2025
Respiratory Therapy Assessment Note - Adult/Pediatric (SHA 0574)
(PDF 476.58 KB)
Published April 24, 2025
Respiratory Therapy Assessment Note – Neonate (SHA 0575)
(PDF 470.07 KB)
Published April 24, 2025
Respiratory Therapy Discharge Transfer Note (SHA 0531)
(PDF 124.44 KB)
Published April 24, 2025
Respiratory Therapy Procedure Note - Lung Ultrasound (SHA 0535)
(PDF 121.65 KB)
Published April 24, 2025
Respiratory Therapy Progress Note (SHA 0579)
(PDF 126.13 KB)
Published April 24, 2025
RSV Program Referral Form - Increased Risk (SHA 0618)
(PDF 146.67 KB)
Published August 28, 2025

S

SAFE-T Protocol with C-SSRS - LTC Suicide Prevention (SHA 0338)
(PDF 790.05 KB)
Published September 10, 2024
SANE Forensic Examiner Program Referral (SHA 0624)
(PDF 123.25 KB)
Published August 22, 2025
SANE Virtual Care Provider Checklist (SHA 0640)
(PDF 101.09 KB)
Published October 21, 2025
Saskatchewan Transfusion Adverse Event Report (TAER) (SHA 0481)
(PDF 283.24 KB)
Published November 6, 2024
Scott Fall Risk Screening Tool for Residential Care (SHA 0363)
(PDF 790.19 KB)
Published November 22, 2023
Sexual Assault Examination Guide Record - SANE (SHA 0317)
(PDF 1.69 MB)
Published September 1, 2023
Sexual Assault Follow Up Letter - Practitioner (SHA 0316)
(PDF 618.9 KB)
Published June 18, 2024
Sexual Assault Health Provider Communication Tool - SANE (SHA 0349)
(PDF 514.22 KB)
Published October 31, 2023
SHA Donation Program - Progress Notes - SCM Downtime (SHA 0257)
(PDF 425.73 KB)
Published March 7, 2023
Short Stay Bed Request Form (SHA 0614)
(PDF 4.62 MB)
Published March 24, 2026
Skin and Wound Care Audit - Data Collection Sheet (SHA 0361)
(PDF 695.68 KB)
Published December 6, 2023
Skin Inspection and Bath Water Temperature Checks (SHA 0302)
(PDF 742.55 KB)
Published October 11, 2023
Stroke Prevention Clinic Nurse Referral (SHA 0602)
(PDF 146.36 KB)
Published February 5, 2026
Stroke Screen - Rural and Remote (SHA 0359)
(PDF 184.28 KB)
Published February 26, 2026
Subjective Opiate Withdrawal Scale (SOWS) (SHA 0678)
(PDF 130.73 KB)
Published January 26, 2026
Swallow Screen - 3 Ounce Water Challenge (SHA 0566)
(PDF 197.95 KB)
Published April 14, 2025
Symptom Assessment Acronym Tool - OPQRSTUV (SHA 0234)
(PDF 527.87 KB)
Published October 7, 2022
Syphilis - Contact PCP Letter (SHA 0381)
(PDF 897.25 KB)
Published July 5, 2024
Syphilis - Final Notice Letter (SHA 0312)
(PDF 851.83 KB)
Published January 10, 2024
Syphilis in Pregnancy - Treatment and Serology Summary (SHA 0382)
(PDF 892.88 KB)
Published December 22, 2023
Syphilis Reactive Serology - Practitioner Checklist (SHA 0239)
(PDF 617.43 KB)
Published April 8, 2024
Syphilis Screening - Pregnancy (SHA 0284)
(PDF 642.49 KB)
Published June 28, 2023
Spirometry Skill Certification (SHA 0697)
(PDF 789.49 KB)
Published February 25, 2026
Spirometry Screening (SHA 0698)
(PDF 719.67 KB)
Published February 25, 2026

T

Therapy Services Progress Note (SHA 0356)
(PDF 445.43 KB)
Published October 31, 2023
Transfusion Administration Record (TAR) (SHA 0479)
(PDF 249.73 KB)
Published November 8, 2024
Transfusion Administration Record (TAR) - Multi-Unit (SHA 0625)
(PDF 175.01 KB)
Published October 6, 2025
Triage Assessment Record - ADULT (SHA 0079)
(PDF 242.58 KB)
Published May 13, 2022
Triage Assessment Record​​ - PEDIATRIC (SHA 0080)
(PDF 246.74 KB)
Published May 13, 2022

U

Urgent Care Centre - Discharge Summary (SHA 0432)
(PDF 660.29 KB)
Published June 28, 2024
Urgent Care Centre - Patient Care Record (SHA 0431)
(PDF 478.02 KB)
Published June 28, 2024
Urgent Care Centre - Primary Assessment (SHA 0430)
(PDF 513.42 KB)
Published June 28, 2024
Urinary Catheter Irrigation Record (SHA 0330)
(PDF 187.16 KB)
Published August 22, 2025

V

Vancomycin Monitoring Form - Adult (SHA 0216)
(PDF 464.97 KB)
Published September 21, 2022
Virtual Care Appointment Record (SHA 0030)
(PDF 459.59 KB)
Published November 16, 2023

W

Weekly Support Surface Checklist - Long Term Care (LTC) (SHA 0437)
(PDF 503.83 KB)
Published October 31, 2024

X - Y - Z

Xylazine Drug Checking Strips [AVERY Labels 5164] (SHA 0554)
(PDF 366 KB)
Published March 13, 2025