Medical Forms & Templates
Jump-start your form design with a professional Jotform medical form template. They are fully customizable and easy to edit!
HIPAA compliance is as low as $29/month. Please follow the HIPAA rules to ensure that your handling of personal health information complies with HIPAA.
Healthcare Form Templates
Registering new patients or learning about previous medical history are some of the processes made easier with our collection of online healthcare form templates. Our form builder provides Healthcare practitioners with an array of widgets, applications, and themes to enhance patient engagement. Enabling better communication between patient and provider, to better understand patients and their needs.
Get started by choosing one of our healthcare templates or start your customizing your own form. Additionally, JotForm offers the simple way to update medical history, acquire consent signatures, collect bill payments, find new business, and more. Plus, JotForm offers HIPAA compliant forms, so your paper healthcare forms are secure.
View our full collection of online healthcare form templates below.
Health Declaration Form
Sharing this Health Declaration Form that is intended to be used by many businesses is based on the Health Declaration Forms used by the Philippine House of Representatives and Malacañan Palace in relation to the COVID19 response. You can choose the option to encrypt the responses with Jotform to ensure the privacy of responses from our customers. Together, #WeRecoverAsOne!
Hospital Discharge Form
This hospital discharge form is suitable for hospitals and clinics worldwide. The staff of hospitals can use this form to ensure all requirements are meant before a patient is discharged. The form is very detailed and contains every essential information needed. However, if this sample hospital discharge form does not contain one or more fields you needed, you do need to worry. You can easily edit the sample discharge form to ensure that it meets your hospital's format. And editing this hospital discharge form is very simple. You do not need coding skills. Why not start using this form today to capture the information you need before discharging patients.
Massage Therapy Client Intake
Never thought you needed therapy? You can sign up for massage therapy with massage intake form template and you can create a HIPAA Compliant. Also, client intake form massage is used by Chiropractors. Massage therapy intake contains different questions about personal information, contact information, history of pathology and the client's symptoms.
Patient Supplies Order Form
Keeping a clear and organized medical order in the healthcare business is important because it saves time and enhances the efficiency of their medical order. This patient supplies order form is mostly used by medical staff and hospitals. The objective of this form is to assist and help medical staff for keeping the records of used supplies by patients. The form will need information such as patient information and medical supply information. The costs incurred for each service and the materials are also needed to complete the form.
Psychiatric Evaluation Form
Use this neat and well-detailed psychiatric evaluation form to collect information about your psychiatric patients. This psychiatric evaluation form template can be customized to collect family history, list out symptoms and fields to input your examinations. Through Jotform your psychiatric evaluation template has access to an assortment of widgets and apps to make collecting the evaluation information easier. Get started with this our psychiatric evaluation form sample for a head start or create your own blank psychiatric evaluation form. Create a HIPAA compliant psychiatric evaluation form template today!
Healthcare PDF Templates
Trust, privacy, and security are the pillars that support every company in the Healthcare Industry. Each of these are carefully woven into their workflow and are intricate parts of the system they all live in. When you're in charge of someone else's healthcare needs, it's important to establish your company as a clean, trustworthy and professional business. A patient's well-being is not something anyone can afford to take a chance on. So, hospitals and medical practitioners go to great lengths to make sure that their patients will trust them.
That’s why the HIPAA compliance act was put in place – To ensure the privacy of the patients’ medical records. And you’re in luck with JotForm being one of the few companies in the online form building industry that is HIPAA-compliant. With our PDF Editor, anyone in the Healthcare Industry can create fillable PDF forms or generate PDF documents as an attachment to their Autoresponders. Instead of designing one from scratch, we offer a wide variety of PDF templates that you can use as an inspiration for your next design project.
These PDF templates can be used in many use case scenarios. For example, you need to hand out brochures about the health services you offer. Instead of handing out paper-based flyers and pamphlets, why not use something like an electronic brochure in PDF format? You can distribute these to your potential patients right after they fill out their information through an online registration form for new patients. Or, you can design a simple yet beautiful fillable PDF form that you can download and print as a paper-based form in case you need one for your hospital’s outpatient department.
Professional Medical Release
This Medical Consent PDF template includes knowledge belong to your clients such as their contact, work, spouse, policyholder, in case of an emergency contact information, the consent, and signature. In addition, you can create a Medical Consent PDF template with HIPAA Compliant.
It is a good practice to always crosscheck and make sure that everything is in order before discharging a patient. In order to ensure this, hospital management usually has a form which they fill and check in before discharging a patient. In our world today where people are using less of paper, this hospital discharge template is one PDF document you can use to save patient discharge information. The essence is that you can easily check the information saved in the PDF document to ensure a patient can be discharged. The hospital discharge letter template here can be modified to suit your taste.
A Pregnancy Verification document is used in hospital, maternity, and lying-in clinic settings. This is given to a woman who gets positive feedback on pregnancy tests. This document also serves as proof that a woman is pregnant which can be used for medical examination, filing a maternity leave, and claiming health insurance.This well-designed Pregnancy Verification Template contains information about the patient, pregnancy, and ob-gynecologist. The pregnancy details show the estimated date of conception, last menstrual period, estimated delivery date, age of gestation, and the number of fetuses. This template also specifies if the mother has a medical condition, illnesses, and allergies.
Online Therapy Consent
This Online Therapy Consent contract sample is a perfect fit for you, if you want to check your patients' crucial data and record their data without any problem. By using this Online Therapy Consent PDF template, you can get online permission from your patients. Moreover, you can print out your consent PDF template for the patient's patient folder. You may collect personal information such as their name, birth date, and contact information. Also, you may inform your patients about their rights with respect to telemedicine with their signature. In addition, you do not have to worry about your data's safety, our forms have HIIPA Compliance.
Release of Information
Privacy is a prevalent issue nowadays where there has been enforcement of privacy laws such as GDPR and HIPAA. These laws provide protection to the person's privacy and thus, an organization or an individual cannot just use, process, or disclose someone else's information without the consent of the information owner. This is where a Release of Information form comes in. A Release of Information is a document signed by the authorizing person owner, allowing the recipient or holder of the information to disclose or use the information through the consent of the owner. In respect and with the rise of privacy laws on countries, it is safe to assume and has become a common practice that a release of information is needed before one can process the data of the owner. This Release of Information PDF template contains the necessary information that the owner consents to for the recipient to release information. This template can be used for processing to what specific kind of request is to be made, what information is to be released, and up until when the consent will maintain to be effective. To prevent any possible matters of litigation, it is best to exercise this practice of requiring the consent of the owner before processing the data of the person.
Client Progress Report
Client Progress Report for Psychotherapy PDF template provides the essential information that should contain in a clinical psychotherapy report such as the name of the patient, the type of session made with the patient, the date of the session, a comprehensive assessment, and treatment goals and objective for the patient/client.
Insurance is usually offered by organizations to their clients, customers such as passengers, or employees. It helps protect the company or an institution in cases of fortuitous events incurring liabilities. However, insurance companies usually do not allow double insurances or it causes more problems rather than solutions where each provider will try duking out each other who shall be responsible to compensate the insured. Or it becomes an additional cost to the insured which may possibly be an expense they cannot afford. In such instances, the companies or institutions need to document that their subject who prefer to opt-out from the insurance that they offer. Thus, an insurance waiver is needed. This Insurance Waiver PDF template helps give clients, customers, or employees an option to opt-out from the insurance being offered by companies or institutions and helps document a formal request that the supposed insured shall not be part of the program offered by an institution to its clients and employees.
Summer Camp Parental Consent
When organizing summer camp programs, you need to provide as much information as possible about camp rules to parents and guardians. With Jotform’s Summer Camp Parental Consent PDF Template, you can create a personalized and detailed consent form parents will actually want to read. You’ll also be able to save all submitted online responses as PDFs that can easily be downloaded and shared with camp staff. Using Jotform’s PDF Editor, you can rewrite the provided text to better describe your camp’s unique policies and services. No coding skills needed — just drag and drop elements until you’re satisfied with the template layout. Once you’ve finished making modifications, your template will automatically convert any submitted responses into PDFs that will be as safe as your campers.
Patient Progress Report
A progress report is a written document that is vital in health care settings because this is where the health care practitioner will base their next plan of treatment. A good health progress report follows the ADPIE (Assessment, Diagnosis, Planning, Intervention, Evaluation) format. Using this Patient Progress Report Template, you will be able to determine if the treatment being applied is effective or not. This Sample Patient Progress Report Template has the patient's personal information, physiological and psychological health progress. The progress report specifies the patient's mood, communication, appearance, emotional status, mental stability, interventions, and respond to treatment, and the report summary.
First Aid Incident Report
Incidents must be reported and recorded to be sure that correct actions and treatment are made which should trigger management awareness and an investigation. The First-Aid Incident Report template contains injured person's personal details and contact details, the details and visible symptoms of injury, the Glasgow Coma Scale which is a neurological scale that expects to give a dependable and target method for chronicle the condition of an individual's awareness and brief information of treatment. Also, it contains the profile of the first-aider and signature of the person who prepares the report. Plus, Jotform is HIPAA-compliant and that is gigantic in addition to for anybody in the medicinal services industry.
HIPAA Release Form
HIPAA (Health Insurance Portability and Accountability Act), also known as Public Law 104-191, is a law passed in the United States that protects and safeguards the privacy of medical information and has two main purposes: First, to provide continuous health insurance coverage to workers who switch jobs or lose their jobs; Second, is to standardize the electronic transmission and transactions for security and protection of information. This law was primarily passed due to proliferation of data breaches concerning health information.This HIPAA Release Form PDF Template is a standard release authorization form for disclosure of health information for healthcare and health insurance providers which the subject or person consents on disclosing his health information to a certain healthcare organization. This HIPAA Release Form PDF Template is easy to modify and flexible to use.