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SUNY Downstate Medical Center
Downstate Depot - Central Stores

UHB Forms

Central Stores INFO

Phone: 718-270-1514
Fax: 718-270-1266
MailStop: 61
Email: Reception Desk - Gail Moore
Location: UH B-526. Enter thru Downstate Depot Reception UH B-530A; opposite Medical Records.
Hours: M-F 9am to 5pm. Your order must be received by 4:45 pm in order to be processed by 5pm.
Asst Director Kevin LeDoux, 718-270-4254
Deputy Director Victor Haynes, 718-270-3074

To order, use Customized UHB Nursing Station & Clinical Labs CStores Order Form - two versions available:

2 page format- prints on 14" paper or

3 page format- prints on 11" paper

UHB (Medical Record) FORMS in STOCK

The following UHB Health Information Management (HIM aka Medical Records) Forms are reproduced in the Quick Copy Center, and distributed to UHB units via Central Stores.

Click on the Form # to view the actual form - to confirm that is the Form you need.

SD014L Interdisciplinary Patient/Family Education Record (Sorry, not yet available-awaiting Med Records Director to provide clean crisp original)

SD015A Problem List Interdisciplinary Plan of Care

SD015B Interdisciplinary Plan of Care

SD015C Problem List Interdisciplinary Plan of Care

SD015D Problem List Interdisciplinary Plan of Care Continuation Page

SD016 Inpatient Diet Order

SD017 Medication Record

SD061C Dept. Internal Medicine Progress Notes

SD075 Adult Risk/Fall Assessment Tool

SD0085 Acknowledgement of Photo/Video Rule in Delivery Room

SD149 Universal Protocol Checklist

SD212 Diabetic Record (Sorry, not yet available-awaiting Med Records Director to provide clean crisp original)

SD215 Advance Directive Status Form

SD314 Nursing Referral Fax Form

SD336 Authorization for Photo/Video of Patient

SD339 Consent to Surgery or Procedure

SD354 Face-to Face Assessment

SD355 Consent to Autopsy

All other forms must be sent to State Purchasing with a Requisition for processing