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MCN ToolBox Entries

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Sample Health Center Mission Statement 1

A sample statement of health center mission and guiding principals.
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Derechos del Paciente

Patient Bill of Rights in Spanish.
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Patient Bill of Rights Spanish

Sample patient bill of rights in Spanish.
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Patient Bill of Rights English

Sample patient bill of rights in English.
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Quality of Self Management Goal-Setting

Setting goals with patients is an important step in helping them self-manage their own health-related behaviors. Experienced healthcare teams find that following the two basic principles described below helps patients have more early success, and small successes one after the other builds confidence and effective self-management.

High quality goals are patient-centered and behaviorally specific. Developing high quality goals increases the likelihood of early and sustained self-management success. Modeled after one team’s efforts, the rating scale below represents a simple way to assess if the goals we set are behaviorally specific.

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Family Planning Concurrent Quality Review Tool

Quality review form for use in family planning programs.
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Patient Satisfaction Form 3

A sample patient satisfaction form that is commercially available, in English and Spanish.
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Patient Satisfaction Form 2

A more involved 2-page sample form given to patients to evalluate their overall experience at the clinic.
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Patient Satisfaction Policy Statement

A sample health center policy for assessing patient satisfaction.
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Sample Quality Council Minutes

A sample of one form of quality council minutes that can be adapted for use in other health centers.
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