Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
An Authorization for Disclosure of Health Information is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.
The form's purpose is to obtain patients signature to be able to use or disclose health information.
English and Spanish bundled together.
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.
Medical Practice Surgery Cancellation Policy, provides information regarding the physician's surgery scheduling and rescheduling policy. It covers areas for scheduling an in-office procedure, scheduling surgery, rescheduling surgery can cancelling surgery, plus fees associated. Acceptance date and signature lines at bottom of form.
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.
General guidelines to using a Walker. A patient's and caregiver guide to using a walking. Protect yourself, be sure you have outlined safety precautions to the patient and leave a safety guidelines sheet with the walker.
Proper, specific, and reproducible labeling of anatomic locations of dermatologic lesions or therapy is important to record as part of a patient's medical history. These drawings can serve as a list of locations treated (e.g. with Botox, etc.) proving very useful on patient's next visit.
A list of frequently asked questions about Botox and Botox injections, patient handout / leaflet. Easily editable using word processor.
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. For use in California.
A 2 page, Botox®, 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. Form may be modified or edited to meet your own practice needs and or other types of fillers and treatments.
The form's purpose is to obtain patients signature acknowledging that patient received the HIPAA Privacy Practices Notice.
Did You Know? Under the HIPAA Privacy Rule, the local health department is required to disseminate its Notice of Privacy Practices to all patients upon the first delivery of service after April 14, 2003, and to make a good faith effort to obtain the patient's acknowledgment that he or she has received the Notice.
General cosmetic surgery preoperative and post-operative guidelines will help to help your clients and patients to adequately prepare ahead of time. Avoid emergencies and legal issues, be sure that your patients follow your exact pre-op and post-op instructions. 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.
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.