Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
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.
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 form recognises that there are patients, members of the community who cannot speak English, and others that have other communication needs. This translation statement is intended to ensure that measures are in place across the office to support communication with everyone whose first language is not spoken english, does not communicate by the spoken work or has any form of communication difficulty.
The form acknowledges that the health care or interpreter has explained the procedure or course of treatment to the patient to the best of his/her ability and acknowledges that he/she believes the patient has understood. Signature and date lines for patient and interpreter.
Protect your rights, be sure non English speaking patients have had all procedures explained, what procedure is likely to involve, including risks, alternative treatments, including no treatment and any particular concerns to patient and that he/she fully understood, avoid legal issues along the way.
Did You Know? Responsibility for arranging translation or interpreting services lies with the organisation and not the service user.
A patient's guide listing frequently asked questions about Restylane® and Restylane injections, patient handout / leaflet. Easily editable using word processor.
Put your clients at ease and provide them with Restylane injection information.
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 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 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.
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 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.
Botox Therapy Consent Form. Patient authorizes physician to perform Botox injections and is informed of all that is related to the procedures such as the proposed treatment, anticipated benefits, risks and complications associated with treatment, Botox limitations and alternatives, costs/fees, follow ups, photographs, etc. Consent signature is at bottom and patient consents that all above questions have been answered and accepts the risks and complications of the procedure.
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.
myMed Kit for Restylane® Practice provides you with 28 (Some forms may contain 2 and 3 pages), state-specific, necessary forms to start your Restylane practice or can be used to replace your old, outdated and faded existing practice forms. Forms have been developed under the direction of cosmetic practice physicians, medical staff, medical attorneys and form developers to provide you with aesthetically designed, legal forms that are pleasing and relaxing to your clients when requesting their signature on legal forms, preventing client confusion and disappointment.
Doctors wanting to immediately add Restylane to their list of services will find myMed Kit for Restylane® an indispensable forms tool kit offering a wide array of forms at minimal expense, saving you valuable time and money. Existing cosmetic practice can do away with old, faded and outdated legal-looking and scarry forms and update their office forms and client and patient perception of your office setting without the added expense of form design and reprint.
Tip: Many physicians overlook the value of having professional office forms that accurately reflects their brand image, many times you see them copy the same forms over and over again until they are hardly visible to read and do reflect a careless image on your work methods, yet this small piece of paper can be an important part of your collateral package. It's often the first item new patients receive from your staff, so it's your first opportunity to make a strong, positive impression on them.
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.
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.
This release form is used to obtain client authorization to take before and after photographs for documentation purposes. It also grants the physician, if agreed by the client, permission to use such photographs in other types of publications.