Skip to content
CHCACT logo
Information For Patients
Donate
  • About
  • Programs
  • Advocacy
  • Partnerships
  • News & Events
  • Training
  • Jobs
  • Contact
CHCACT logo

Sample Policies & Forms

HR Director resources are password-protected. Please make sure you are logged in to view them.

[protected]

Policies

  • Absenteeism Policy
  • Credentialing Policy
  • FMLA Policy
  • Notice of Privacy Practices
  • Inclement Weather Policy
  • Intern Procedure
  • Staff as Clients Policy
  • Termination of Care Policy
  • Social Media Policy
  • Sample Social Media Policy
  • Employee Referral Bonus Program Policy

Forms & Checklists

  • Authorization for Release of Protected Health Information
  • EHR Incentive Addendum Form
  • Insurance Analysis Spreadsheet
  • Intern Checklist
  • Intern Pre-Placement Checklist
  • Intern Pre-Screen Credentialing Questions
  • Opt-Out Waiver Form
  • Short-Term Disability Letter

Background Checks

  • Release Authorization Form
  • Employers Reference Source – Quote
  • Employers Reference Source Release Form

Reviews & Evaluations

  • Annual Evaluation Form
  • CEO – Board Evaluation Questions
  • CEO – Performance Goals
  • Coworker Review
  • Employee Performance Appraisal (Management Version)
  • Employee Survey
  • Employee Survey (2)

[/protected]

About CHCACT

CHCACT plays an active role in health policy discussions by participating on key advisory councils. We provide on-going information on community health center programs and clinical performance to Connecticut's decision-makers, elected officials and residents.

Site Navigation

About
Programs
Advocacy
Partnerships
News & Events
Training
Resources
Jobs

Support CHCACT

Resources

Find a CT Health Center
Access Health CT
Login / Manage Jobs

Contact Us

Contact Details

Community Health Center Association of Connecticut
1484 Highland Avenue
Suites 2 & 3
Cheshire, CT 06410

(860) 667-7820
(203) 250-0040 (fax)
 

© 2023 Community Health Center Association of Connecticut (CHCACT)

  • Home
  • For Patients: Find a Health Center
  • About CHCACT
  • CHCACT Programs
  • Advocacy & Involvement
  • Partners & Funders
  • News & Events
  • Training & Education
  • Job Postings
  • Contact Us
Search