Healthcare

About this category:

Patients use various forms to make decisions about their medical care, such as consent forms, advance directives, medical records, release of information forms, power of attorney, and living wills.

Templates in this category:

Advance Directive (Maryland)

This document template allows a Maryland resident to appoint a health care agent and provide instructions for end-of-life care.

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Advance Directive (Virginia)

This document template provides a Virginia resident with the ability to appoint an agent to make health care decisions, receive protected health information, and provide instructions for a terminal illness, as well as direct an anatomical gift.

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Advance Directive for Health Care (Alabama)

This document template provides an advance directive for health care for a competent adult residing in Alabama, including instructions regarding particular health care treatments and notes and drafting tips.

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Advance Directive for Health Care (Georgia)

This online document is a Georgia-specific advance directive that allows an individual to appoint an agent to make health care decisions on their behalf and provide instructions for particular treatments, including life-sustaining treatments, organ donation, and disposition of remains.

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Advance Directive for Health Care (New Jersey)

This document template allows a New Jersey resident to appoint a health care representative to make health care decisions, including instructions for life-sustaining treatments and end-of-life care.

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Advance Directive for Health Care (Tennessee)

This document template allows a Tennessee resident to appoint someone to make health care decisions, including instructions for life-sustaining treatments or end-of-life care.

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Advance Directive for Mental Health Care (New Jersey)

This document template allows a New Jersey resident to provide instructions to a health care provider regarding mental health medications, treatments, and admission into a mental health facility, and appoint a third party to make decisions if necessary, with integrated notes and drafting tips.

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Advance Health Care Directive (California)

This document template allows a California resident to appoint an agent to make health care decisions and receive health care information, with the option to include instructions for particular treatments, including life-sustaining and end-of-life care.

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Advance Health Care Directive (New Hampshire)

This document allows an individual in New Hampshire to appoint an agent to make health care decisions and provide instructions regarding health care treatments, including the withholding or withdrawing of life-sustaining treatments.

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Advance Health Care Directive (Utah)

An advance health care directive in Utah allows a declarant to express preferences for health care treatments and to appoint an agent to make decisions if the declarant is unable to do so, including directives for withholding or withdrawing life-sustaining treatments.

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Advance Health-Care Directive (Delaware)

This document template allows an adult to authorize an agent to make health-care decisions and receive health information on their behalf, as well as provide written instructions for withholding or withdrawing life-sustaining treatments.

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Advance Health-Care Directive (Hawaii)

This document template allows individuals in Hawaii to provide written instructions and authorize an agent to make health-care decisions on their behalf, including directives for life-sustaining treatments or end-of-life care.

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Advance Health-Care Directive (Mississippi)

This document template allows a Mississippi resident to appoint an agent to make health-care decisions and receive health information on their behalf.

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Certificate of Group Health Plan Coverage

This template provides a certificate of group health plan coverage based on a template published by the Department of Labor, with integrated notes for important explanations and drafting tips.

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Certification of Health Care Provider for Employee's Pregnancy Disability (California)

This template form provides employers with five or more employees a California-compliant medical certification for pregnancy disability leave (PDL), transfer, and/or reasonable accommodation in accordance with California law.

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Certification of Health Care Provider of Serious Health Condition (California)

This is a template form for a California-compliant medical certification under the CFRA for a health care provider to certify an employee's serious health condition, updated to comply with the California Civil Rights Department as of July 1, 2022.

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Code of Conduct For Hospitals & Hospital Systems

This online document provides a template for a code of conduct for a hospital or other health care provider to use as part of its compliance program, based on federal law and with integrated notes.

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Declaration for Mental Health Treatment (Illinois)

This template provides instructions and preferences for mental health treatment, including medications, treatments, and admission to a health care facility, to an attorney-in-fact and health care provider.

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Declaration for Mental Health Treatment (Texas)

This document template provides instructions to a health care provider regarding psychoactive medications, convulsive treatment, and emergency mental health treatment, with integrated notes and drafting tips.

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Declaration of Natural Death (Kansas)

This document template allows individuals in Kansas to provide instructions regarding end-of-life care and life-sustaining treatments, commonly referred to as a living will.

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Directive to Physicians (Texas)

This document template allows individuals to provide instructions for medical treatment in the event of a terminal or irreversible condition, as well as express religious or moral considerations.

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Emergency Medical Care Policy (without Emergency Department)

This online document provides a template for emergency medical care policy for hospitals and facilities without dedicated emergency departments, based on federal law and including ACA requirements.

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Exchange Notice for Employers Who Do Not Offer a Health Plan

This document template provides an easy way for employers to inform their employees about health insurance availability.

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Executive Committee Charter For Non-Profit Hospitals & Health Care Organizations

This template provides a form for the executive committee of a non-profit hospital or health care organization's board of directors to create a charter.

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FMLA Certification For Serious Injury or Illness of Current Servicemember For Military Caregiver Leave

This document provides an outline template form for requesting certification of a serious injury or illness of a current military servicemember when an employee requests military caregiver leave under the Family and Medical Leave Act (FMLA).

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FMLA Certification of Health Care Provider For Family Member's Serious Health Condition

This online document provides an outline template form for requesting certification of a family member's serious health condition under the Family and Medical Leave Act (FMLA) for employees requesting FMLA leave.

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FMLA/CFRA Eligibility, Rights, and Responsibilities (California) Notice

This template provides private employers with at least 50 employees a form to notify California employees of their eligibility for leave and their rights and responsibilities under the FMLA and CFRA, with integrated notes for important explanations and drafting tips.

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Facility Medical Director Job Description (General)

This template provides a general job description for a Medical Director that can be tailored to the needs of hospitals, ASCs, and other health care facilities.

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Federal Sector Employee Request For Medical Exception to COVID-19 Vaccination Requirement

This template provides federal employers with a form to use when granting an exception to the COVID-19 vaccination requirement for employees with disabilities, based on federal law and a template drafted by the Safer Federal Workforce Task Force.

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HIPAA Authorization to Use & Disclose PHI

This authorization form allows an individual to provide permission to a covered entity under HIPAA to use or disclose their protected health information (PHI) for specific purposes, in accordance with HIPAA requirements but not necessarily state law.

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HIPAA Authorization to Use & Disclose Protected Health Information For Clinical Research

This document template allows research subjects to authorize an organization conducting a clinical trial regulated by the FDA to use and disclose PHI under HIPAA regulations.

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HIPAA Data Use Contract (DUA)

This paragraph describes a template contract for the disclosure of a limited data set between a HIPAA covered entity and recipient, as allowed by the HIPAA Privacy Rule.

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HIPAA Hybrid Entity Policy

This template policy outlines an entity's HIPAA compliance obligations when electing hybrid status under HIPAA.

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Health Care Collaboration Contract with Non-Physician Practitioner

This template provides a collaborative practice contract between a physician and a nurse practitioner, and can also be used for other types of non-physician practitioners (NPPs).

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Health Care Contract Review & Approval Policy

This policy template provides a comprehensive guide for health care organizations to legally review and prepare contracts, request contracts, and obtain internal approval.

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Health Care Directive (Minnesota)

This document template allows a Minnesota resident to appoint a health care agent to make health care decisions and provide personal instructions regarding health care treatments, including life-sustaining treatments or end-of-life care.

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Health Care Directive (Washington)

This document template creates an advance health care directive in Washington, allowing a declarer to provide instructions for the withholding, withdrawing, or continued administration of life-sustaining treatment in the event of a terminal or irreversible condition.

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Health Care Exclusion List Screening Policy

This policy provides a template for health care entities to screen individuals and entities against exclusion lists to avoid penalties and sanctions.

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Health Care Power of Attorney (South Carolina)

This document template allows a South Carolina resident to appoint a health care agent to make health care decisions and receive health care information on their behalf, including instructions regarding particular health care treatments and directives regarding life-sustaining treatments or end-of-life care.

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Health Care Provider Professional Services Contract (Facility-friendly)

This contract provides professional medical services to a hospital or other facility, with terms that favor the facility party, and includes provisions to satisfy federal health care program requirements.

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Health Care Proxy (Massachusetts)

This document template allows Massachusetts residents to appoint a health care proxy to make health care decisions, including personal instructions for treatments and end-of-life care.

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Health Care Proxy (New York)

This document template provides a New York resident with the ability to appoint a health care agent to make health care decisions and includes instructions for particular treatments, including life-sustaining and end-of-life care, as well as links to a Practice Note for counsel.

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Health Care Vendor Disclosure Statement & Certification

This template provides a Disclosure Statement for health care organizations to use to screen and vet vendors of medical products and supplies for conflicts of interest, based on federal law and requirements applicable to federal health care program participants.

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Hospital Emergency Medical Care Policy (with Emergency Department)

This online document is a template policy for emergency medical care that meets the requirements of the Emergency Medical Treatment and Labor Act (EMTALA) and the Affordable Care Act (ACA), with potential additional requirements based on state or local law.

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Hospital Financial Assistance Policy

This document provides a template for a Financial Assistance Policy containing the Internal Revenue Service (IRS) requirements for non-profit hospitals, with potential additional state or local law requirements to be integrated.

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Hospital Financial Assistance Policy Plain Language Summary

This template provides a plain language summary of financial assistance and charity care programs for non-profit hospitals, based on federal requirements and potentially supplemented by state or local law.

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Informed Consent Template For Expanded Access to an Investigational Drug

This online document is an informed consent template for a patient to access an investigational drug, meeting FDA requirements and industry standards.

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Living Will (Illinois)

This document template enables individuals to make end-of-life decisions in the event of a terminal illness.

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Medical Power of Attorney (Texas)

This online document is a medical power of attorney template which allows an individual to appoint an agent to make health care decisions in the event of incapacitation, with the option to provide instructions or limit the agent's decision making authority.

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Medical Power of Attorney and Living Will (West Virginia)

This template provides an individual with a combined medical power of attorney and living will, with integrated notes and drafting tips.

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Medical Record Documentation Policy

This online document is a Medical Record Documentation Policy template based on federal law, which can be adapted to meet additional state laws and regulations.

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Medical Staff Conflict of Interest Disclosure Statement

This online document is an annual conflict of interest disclosure statement for physician members of a hospital medical staff, which requests information about potential conflicts of interest and requires an attestation of truthfulness.

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Medicare Delegation Oversight Policy

This document provides a template for MAOs and PDPs to follow when delegating responsibility to FDRs to ensure Medicare compliance.

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Patient Advocate Designation (Michigan)

This document template allows a Michigan resident to designate a patient advocate to make health care decisions and receive protected health care information, with the option to include personal instructions regarding specific health care treatments.

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Physician Employment Contract with Hospital or Health Care Organization

This online document is a template for a contract setting out the terms and conditions for full-time employment of a physician, taking into account the Stark Law and Anti-Kickback Statute (AKS) regulations, including the 2020 revisions.

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Policy on Policies For Health Care Organizations

This policy template provides a comprehensive approach for health care organizations to develop, document, approve, implement, update, retain, and evaluate policies that are compliant with legal, compliance, and licensure requirements, and reflect the organization's mission and standards.

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Policy on Purchases from Physician-Owned Distributors (PODs)

This policy provides guidance to institutional health care providers on managing legal risks associated with physician-owned distributors (PODs) or other vendor entities financially connected to physicians.

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Power of Attorney for Health Care (Wisconsin)

This document template allows a Wisconsin resident to appoint an agent to make health care decisions, including personal instructions regarding treatments and end-of-life care.

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Power of Attorney for Health Care Decisions (Nebraska)

This document template allows a Nebraska resident to appoint a health care agent to make health care decisions and receive health care information on their behalf, with the option to include instructions regarding specific health care treatments.

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Power of Attorney for Health Care Decisions (Washington)

This document template allows a Washington resident to grant an agent the authority to make health care decisions on their behalf, with the option to provide instructions or limit the agent's decision-making power.

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Privacy Laws Representations & Warranties For Healthcare Companies

This Standard Clause provides an outline template for healthcare companies to ensure compliance with data privacy and security laws when included in underwriting contracts in a registered securities offering, with integrated notes and drafting tips.

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Procedures For Identifying Qualified Medical Child Support Orders

This paragraph outlines the procedures for a group health plan to determine if a medical child support order is qualified (QMCSO).

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Statutory Simple Health Care Power of Attorney (North Carolina)

This document allows a North Carolina resident to appoint a health care agent to make health care decisions, including personal instructions for treatments.

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Summary Annual Report (SAR) For Health & Welfare Plans

This SAR provides a simplified financial statement of the plan and informs participants of their rights to receive additional plan information, in accordance with ERISA.

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Surprise Medical Billing For Providers & Facilities: Disclosure Notice

This template provides health care providers and facilities with a disclosure notice to provide to patients as required under the No Surprises Act, based on federal requirements and potentially additional state law requirements.

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