Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
This fact sheet should accompany any concentrator rented to a patient. It will teach patient safe use of an oxygen concentrator. Protect yourself, be sure you have outlined safety precautions to the patient and leave a safety guidelines sheet with the concentrator.
A welcome form, sure to impress your clientele upon receiving it. Learn more about your own clients by obtain information as to the primary reason why they are visiting your cosmetic practice, why they selected your practice and also inquires about other cosmetic procedures they may be interested in being informed and their preferred payment option(s). Easily edit the form to your particular questions using Microsoft Word or other compatible word processor.
With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.
A form authorizing the clinic or doctor's office to charge a patient, certain amount of money if the patient misses his/her's scheduled appointment day, unless said patient informs the clinic or doctor, within a certain amount of hours in advance to cancel or make other scheduled appointment.
This release form is used to obtain client photography and interview permission and includes rules by which patient/client must agree to abide in exchange of value received to client/doctor. Protect yourself if you will be taking photographs and/or will be using any other patient material for any type of purpose, be sure to have your client's permission in writing.
This notice describes to your clients and patients how medical information about them may be used and disclosed and how the patient can get access to this information.
The Health Information Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by a physician, whether electronically, on paper, or orally, are kept properly confidential. This Act gives the patient, significant new rights to understand and control how their health information is used. HIPAA provides penalties for covered entities that misuse personal health information. This information provided to client or patient is required by HIPAA.
A correspondence form to assist in communication and the sharing of information between patient and doctor is important piece. Each phone call, letter, or email is a piece of your patient's story. Sometimes, questions or disputes may arise, and documentation is independent evidence that can clarify details, and help avoid future confusion and misunderstandings.
You may print just a few, as needed, or take the artwork to your local print shop for quantity printing and drilling of holes on top of page.
A superbill is a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement. It is generally customized for a provider office and contains patient information, the most common CPT (procedure) and ICD (diagnostic) codes used by that office, and a section for items such as follow-up appointments, copays, and the provider’s signature.
The super bill is bundled with Microsoft Word forms and a fillable PDF form for use with free Adobe Reader. Both forms can be personalized with your practice name, address, contact numbers, etc. The Word form is fully editable, the PDF form you can only edit your practice business name, address, etc.
A medical release form is a document that gives healthcare professionals permission to share patient medical information with other parties. Patient's must first sign a release.
According to the U.S. Department of Health and Human Services, “An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.”
Did You Know? Verbal medical release agreements are not sufficient because they are impossible to verify if there’s ever a disagreement. Healthcare staff need a written copy on record with a signature to protect themselves. If you are ever instructed to share healthcare information on behalf of a patient, make sure you have them sign a release form.
A patient's guide and checklist for patients using CPAP and BiPAP medical, therapy equipment.
Avoid malpractice suits that can tarnish the physician's reputation and raise malpractice insurance premiums by having your client accept binding arbitration of any dispute, avoiding the client's right to a trial.
A patient's guide to using a Nebulizer. Includes sections and guidelines on: goals, equipment preparation, equipment usage, troubleshooting and safety precautions and additional medication precautions. It also has a section near bottom of form with the medical equipment's business name and a telephone number for the patient have difficulty, needs assistance or does not understand something.
Tip: Protect your medical supply rental business, be sure you have outlined safety precautions to the patient and leave a safety guidelines sheet with any type of medical rental equipment left in location with a patient or caregiver.
General Restylane® post-treatment guidelines will help to help your patients to adequately prepare after the treatment. Avoid emergencies and legal issues, be sure that your patients leaves your office with post-treatment instructions to follow by providing them with this form and keep an office copy. Easily edit the form to your particular instructions using Microsoft Word or other compatible word processor.
This Planning for Cosmetic Surgery brochure is a great planning toolkit and a helpful resource to answer your patient's general questions and address basic information that may be relevant to their plastic surgery experience. Patient safety should be your highest priority and informing your patients will be your biggest asset. Teaching your patients about their options will help them be educated patients, better prepared for physician consultations and ready to decide on which procedure is right for them.
This is a great brochure and editable using Microsoft Word. Easy to personalize, once completed, print, in your office, as many as needed, or deliver camera-ready artwork to your local speedy printer or print shop, for quantity brochure printing.
Superbills aggregate the data from a patient visit needed to successfully submit an insurance claim. This includes provider information, patient information and visit information. Superbills are different from receipts/invoices because they provide additional information regarding the visit (diagnosis and procedure codes) that are needed to get a claim approved.
This New Client Information form can be used to obtain patient information as an intake or registration form. Its contemporary and clean design makes it easy for clients/patients to read and answer the questions. May be used as is, or easily editable using Microsoft Word to assist you in asking only the questions that you wish to obtain from your patients.
This form is used provided to client by physician so he can obtain a comprehensive breast history prior to considering breast surgery.
Includes both, sections for written responses and multiple choice using check boxes. Fully edit the questions to your particular practice needs.
A more complete, 3 page, Restylane®, facial injections consent form. Patient authorizes physician to perform Restylane injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back, it also informs of risks and alternative treatments.
It is divided into several sections, Instructions; Introduction, what Restylane is, what it has been approved for, and general information about the effects; Alternate Treatments; Risks of Restylane; Normal Occurrences During Tissue Filler Injections, Including Restylane; Complications and Health Insurance.
This is a Botox Fee Schedule (or for any other type of dermal filler or any type of procedures where you wish to have a price list), includes procedures, prices, payment schedule and signature line for client. May also be used as a fee schedule form for any other type of surgical procedures, easily edit and change form fields to best meet your needs.
A new patient intake form to help expedite patient's visit and learn about your patients history and reason for visit, with areas to learn more about your patient's other interest in cosmetic procedures. Obtain patient's home and work address, contact & emergency numbers, services requested, areas of cosmetic interest and past cosmetic procedures history, referral, patient signature line, and more. May be used as is, or easily personalized using compatible word processor.
Botox® Treatment Consent to Treat a Minor Form. The parent or guardian of a minor, authorizes physician to perform cosmetic treatment and is disclosed information concerning Botox, how it injected, side effects, what to expect, patient also acknowledges the limitations of Botox treatments and possible side effects and dangers. Patient consent date and signature signature lines at bottom of form. Physician should examine form to see if it may benefit his/her practice to help keep patients legally informed and physician from legal problems.
The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns, and to prompt them to have discussions with their health plans and health care providers and exercise their rights.
Did You Know? The notice must include an effective date, it is your responsibility to add the effective date. See 45 CFR 164.520(b) for the specific requirements for developing the content of the notice. A covered entity is required to promptly revise and distribute its notice whenever it makes material changes to any of its privacy practices. See 45 CFR 164.520(b)(3), 164.520(c)(1)(i)(C) for health plans, and 164.520(c)(2)(iv) for covered health care providers with direct treatment relationships with individuals.
An office, sign-in register for patients to sign-in when they enter the office.
Form may be printed in your office and only print the amount you need or may be delivered to your local print shop for quantity printing.
This form functions as a Prescription and Letter of Medical Verbal Orders for healthcare equipment, medications and special orders. Form also records doctor and patient information.
This form is used used to obtain new patient medical history. Form is divided into 4 sections. Patient information, past medical history, medications, and the last section is reserved for women only. May be used as is, or easily personalized to your individual needs, using compatible word processor.
No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.