Refugee Health Program

Refugee Health Screening

RI Refugee Health Screening Form

The RI Refugee Health Screening Form outlines the minimum standards for an initial health assessment of refugees resettling in Rhode Island. The screening form identifies the baseline evaluation that should be performed with refugees, promotes uniform care, facilitates entry into the primary care system, and identifies surveillance indicators to be tracked and analyzed by the Refugee Health Program. In addition, the Rhode Island Refugee Health Screening Form is a tool for screening doctors to use in making other health referrals as needed.

The tri-part form is to be completed by medical providers who perform the initial assessment. Following the screening:

• The white copy of the form should be faxed of mailed to the Refugee Health Program within 30 days of completion. The fax number and address is listed at the top of the form.
• The yellow copy of the form should be placed in the patient’s medical record
• The pink copy should be provided to the patient.

A downloadable Word copy is available here for reference purposes. Medical providers can obtain additional copies of the tri-part screening forms by contacting the Refugee Health Program at 401-222-2901.