HIPAA Compatible Templates
Patient Medical Record Template
Medical History Record PDF template lets you collect the patient's data such as personal information, contact information in an emergency case, general medical history. By using this sample, the doctor ensures the patient's better care and treatment.
Doctors Note Template
Create a doctor’s note for your medical practice. Sign and send to your patients. Works on mobile, tablet, and desktop devices. Drag and drop to design.
Prescription Template
Use this Prescription Template when prescribing medications or providing treatment regimens to the patients in order to address their health complaints. This PDF document can be opened on mobile devices by using a mobile browser and then opening the standard direct link.
Pregnancy Verification Template
Verify the pregnancies of your clinic’s patients easily. Drag and drop to customize your form. Send out copies. Works on desktop, tablet, and mobile devices.
Online Therapy Consent Template
Create an online therapy consent form to gather patient consent. Sign and fill out on any device. Drag and drop to fully customize. No coding knowledge required.
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.
Release of Information Template
The Release of Information Template is a document that authorizes the disclosure of official or medical records to specific individuals or organizations
Insurance Waiver Template
Create an insurance waiver for employees declining insurance coverage. Works great on any device. Easy to customize and share. No coding knowledge required.
Medical Records Release Authorization
Build a medical records release authorization form in seconds. Works on any device. Android and iOS compatible. Converts to a PDF. No coding knowledge required.
Superbill Template
Generate healthcare superbills fast with a free template from Jotform. Great for all medical providers and specialists. Easy to customize and sync. No coding.
Professional Physical Therapy Consent Template
Create a professional physical therapy consent form. Collect e-signatures on any smartphone, tablet, or desktop. Easy to customize and share.
HIPAA Release Form Template
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.
Professional Medical Consent Template
Create a signable professional medical consent form in seconds. Easy to customize. Fill out and sign on any device. Share via email. No coding knowledge required.
Release of Medical Information Template
Build a release of medicational information form in seconds. Works on any device. Android and iOS compatible. Converts to a PDF. No coding knowledge required.
Acupuncture Medical Consent Template
Create a medical consent form for your acupuncture practice. Drag and drop to customize. Works on all mobile, tablet, and desktop devices. Share and embed.
Blood Donation Consent Template
Create an online blood donation consent form. Fill out and sign on any device. Drag and drop customization. Download as a PDF. Easy to share. No coding needed.
Pet Therapy Consent Form
Collect pet therapy consent forms. Easy online e-sign process. Works on all devices. Drag and drop to customize. Electronic signatures.
Refusal to Vaccinate Form
Create an official form to document parent refusals to vaccinate. Easily customizable. Download the finalized document as a PDF. Works on iOS and Android devices.
Patient Confidentiality Agreement
Create a signable patient confidentiality agreement. Fill out and sign with ease on any device. Drag and drop to customize. No coding knowledge. Save as a PDF.
Medical Power of Attorney Form
Create a medical power of attorney form in seconds. Easy to share and embed. Drag and drop to customize. Fill out and sign on any device. No coding required.
D. Victoria Martin MD JOTFORM (Adult questionaire) new patient
source app: D. victoria martin MD website, ADULT, basic questions,: DOB:gender identity: phone: email: address: emergency contact: Age: , Family History, Relationships w/ family + friends+romantic, marital stats, kids, raised where born where,school like, how far in school, medical issues, any previous psychatrist(s) or therapist(s), hospitalized for a osych episode? meds current or have taken, allergies, genertic mood disorders,smoke/vape?, drink/how much, recreational drugs, how much, check all tha apply i.v drug use?, ( answer N/A-little -some- often- most (yall must be answered))( answer :yes -some- or-no (all must be answered))( answer select the response that est fits NONE< LITTLE<MODERATE<SEVERE(all must be answered))
About HIPAA Compatible Templates
Jotform’s PDF templates provide a convenient solution for businesses, organizations, and individuals looking to create a wide array of documents. From contracts to invoices, inspection reports, and more, these templates cater to diverse needs. For instance, hospitals, clinics, telemedicine providers, and wellness centers might find our HIPAA compatible templates highly useful. The templates provide a ready-to-use, easy means to collect vital data while maintaining a seamless user experience.
Jotform's PDF Editor is an innovative tool that enables users to transform collected data into custom PDF documents online. With its drag-and-drop builder, creating your custom document requires zero technical skill. The automated process ensures that your submission data will automatically populate your chosen design every time. With over 1.5K+ templates, it offers a variety of design inspirations. You can easily customize the template to match your brand by adding logos, changing fonts, or selecting a suitable background. Its seamless sharing feature allows you to email your PDFs to colleagues and customers or embed them in your website in seconds. Jotform PDF Editor truly provides an easy and efficient solution to creating, editing, and sharing your PDF documents.
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.