Patient Resources

Patient Forms

• Adult Health History Form 
• Medical Record Release Form 
• Patient Information Form - English 
• Pediatric Health History Form 

Web Resources

• Intermountain Healthcare Health Resources by Topic 
• My Health 
• Personalized Primary Care 
• Symptom Checker 

Patient Education

• Asthma Action Plan 
• Asthma Action Plan (Spanish) 
• Asthma and COPD: How to Use a Nebulizer 
• Asthma and COPD: How to Use an MDI 
• Asthma Control Test for Ages 12 and Older 
• Asthma Control Test for Ages 4 to 11 Years Old 
• Asthma Symptoms and Triggers 
• Asthma: Breathing Easier booklet 
• Asthma: Breathing Easier booklet (Spanish) 

Patient Education

• ADHD Attention Deficit Hyperactivity Disorder handout 
• ADHD Attention Deficit Hyperactivity Disorder handout Spanish 
• ADHD Talking to your Childs or Teens Teachers 
• ADHD Talking to your Childs or Teens Teachers Spanish 
• ADHD: Talking with Your Child 
• ADHD: Talking with Your Child Spanish 
• ADHD: Tips for Teachers 
• MHI Baseline Packet Child 
• MHI Baseline Packet Child Spanish 
• MHI Follow Up Packet Child 
• MHI Follow Up Packet Child Spanish 
• MHI School Baseline Packet 
• MHI School Baseline Packet Spanish 
• MHI School Follow Up Packet 
• MHI School Follow Up Packet Spanish 

Web Resources

• CHADD of Utah 
• Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) 

Patient Education

• Depression handout 
• Mental Health and a Healthy Heart 

Patient Education

• Carb Counselor: Advice and Tools for Counting Carbs pocket guide 
• Diabetes Care Card 
• Diabetes Care Handbook: Living Well with 
• Diabetes Medication: Aspirin Therapy for Adults 
• Diabetes Medication: Glitazones 
• Diabetes Medication: Meglitinides 
• Diabetes Medication: Sulfonylureas 
• Diabetes Medications: Glucagon 
• Diabetes Medications: Insulin 
• Food Finder and Meal Plan Basics handout 
• Gestational Diabetes 
• Gestational Diabetes Meal Plan 
• Pre-diabetes: Act Now to Protect Your Health 

Patient Education

• Heart Failure 
• Heart Failure Spanish 
• Heart Failure Fluid Tracker 
• Heart Failure MAWDS Diary 
• Heart Failure MAWDS Diary (Spanish) 
• Heart Failure: Living with Heart Failure booklet 
• Heart Failure: Living with Heart Failure Spanish 
• LiVe Well: Nutrition for a Healthy Heart booklet 

Patient Education

• BP Basics: What You Need to Know to Manage Your Blood Pressure booklet 
• BP Basics: What You Need to Know to Manage Your Blood Pressure booklet Spanish 
• BP Tracker: A Tool for Keeping Track of Your Blood Pressure 
• BP Tracker: A Tool for Keeping Track of Your Blood Pressure Spanish 
• High Blood Pressure and the DASH Diet 
• High Blood Pressure and the DASH Diet Spanish 

Patient Education

• Lead Screening Form 
• Prevent a Fall Pediatric Patients 
• Well Child Care Schedule 

Web Resources

• Healthychildren.org