Forms Center
This page includes downloadable Word documents that physician practices may use.
Introduction to Your California Advance Health Care Directive
This document advises on the right to refuse unwanted medical treatment, or to request treatment, in the event the ability to make ones own decisions is lost.
California Advance Health Care Directive
Patient have the right to give instructions about their own health care. They also have the right to name someone else to make health care decisions for them. This form lets patients do either or both of these things. It also allows them to express their wishes regarding donation of organs and the designation of a primary physician.
Business Associate Agreement for Protection of Patient Information
Required by HIPAA, this business agreement can be used by practices working with contractors to ensure that contractors are appropriately safeguarding the protected health information of patients.
HIPAA Privacy Notice
Append this brief paragraph to fax cover sheets so recipients are aware that the contents are confidential and protected under HIPAA.
HIPAA Privacy Policy
This HIPAA privacy policy can be adapted by physician practices.
Non-covered Services
This document includes two release forms for non-covered services. Page 1 is directed toward the Senior Care Program, page 2 for commercial members of health care programs.
Notice of Privacy Practices
Required by HIPAA, practices can use this privacy notice to provide required disclosure to patients regarding protected health information, including privacy rights and practice obligations.
Notice of Privacy Practices - Spanish
Spanish translation of a privacy notice to provide required disclosure to patients regarding protected health information, including privacy rights and practice obligations.
Receipt of Privacy Notice
Acknowledgement that patient has received a copy of the practice’s privacy notice.
Receipt of Privacy Notice - Spanish
Spanish translation of acknowledgement that patient has received a copy of the practice’s privacy notice.
Special Authorization Form
Patient authorization for special use and disclosure of protected health information.
Special Authorization Form - Spanish
Spanish translation of patient authorization for special use and disclosure of protected health information.
eCommunications Agreement Form
If your patients' health plans do not cover electronic communication, you should bill the patient directly. These e-visits should be use for non-urgent matteres and with established patients only. View a sample physician e-mail policy.
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