Health Care Proxy Form
A health care proxy form is an official document that designates a third party to be responsible for a person’s health when that person can no longer make decisions for themselves — be it temporary or permanent. Build a professional, HIPAA-friendly Health Care Proxy Form that works for your needs with Jotform Sign. Create, customize, and send in just a few clicks.
Ensure that your Health Care Proxy Form meets all your specific needs by personalizing it with our easy-to-use form builder. Drag and drop to upload certificates and images, create an automated signing order, make cosmetic changes to colors and fonts, and more. Once you’re finished designing, simply send and wait for confirmation e-signatures. Then all parties involved will receive a copy for their records.
NonProfit Donation Consent Template
Create a nonprofit donation consent form in seconds. Drag-and-drop to design and customize. Collect signatures from any smartphone, tablet, or desktop.
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.
Power of Attorney Form
Create a professional power of attorney form. Signable on any smartphone, tablet, or desktop. Easy to customize and share with others. Converts to PDF.
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
Hospital Discharge Template
The Hospital Discharge Template is a detailed document that provides patients with instructions and information upon discharge from a healthcare facility
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.
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.