![Sample Forms, Checklists and Letters](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/RM%20Banner_Blank_D4.jpg?width=300&name=RM%20Banner_Blank_D4.jpg)
Sample Forms, Checklists and Letters
You deserve top-notch risk resources to help you lessen uncertainty and exert more control. Editable document templates can help you save time. Using sample documents can help establish effective communication methods among your patients and healthcare staff.
Since laws vary from state-to-state, please contact a Risk Management Consultant to discuss specific situations, or if you would like us to review your template modifications.
![Against Medical Advice Discharge Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Against%20Medical%20Advice%20Discharge%20Form%20.png?width=300&name=Against%20Medical%20Advice%20Discharge%20Form%20.png)
Against Medical Advice Discharge Form
Against Medical Advice Discharge Form Read More
![Against Medical Advice Guidelines](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Against%20Medical%20Advice%20Guidelines.png?width=300&name=Against%20Medical%20Advice%20Guidelines.png)
Against Medical Advice Guidelines
Against Medical Advice GuidelinesRead More
![Against Medical Advice Physician Documentation Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Against%20Medical%20Advice%20Physician%20Documentation%20Checklist.png?width=300&name=Against%20Medical%20Advice%20Physician%20Documentation%20Checklist.png)
Against Medical Advice Physician Documentation Checklist
Against Medical Advice Physician Documentation ChecklistRead More
![Chain of Command Flowchart](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Chain%20of%20Command%20Flowchart.png?width=300&name=Chain%20of%20Command%20Flowchart.png)
Chain of Command Flowchart
Chain of Command FlowchartRead More
![Chain of Command Policy Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Chain%20of%20Command%20Policy%20Form%20.png?width=300&name=Chain%20of%20Command%20Policy%20Form%20.png)
Chain of Command Policy Form
Chain of Command Policy Form Read More
![Confidentiality Agreement Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Confidentiality%20Agreement%20Form.png?width=300&name=Confidentiality%20Agreement%20Form.png)
Confidentiality Agreement Form
Confidentiality Agreement FormRead More
![Covid-19 Acknowledgement for Medical Practices](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Covid-19%20Acknowledgement%20for%20Medical%20Practices.png?width=300&name=Covid-19%20Acknowledgement%20for%20Medical%20Practices.png)
Covid-19 Acknowledgement for Medical Practices
Covid-19 Acknowledgement for Medical PracticesRead More
![Covid-19 Telehealth Informed Consent Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Covid-19%20Telehealth%20Informed%20Consent%20Form.png?width=300&name=Covid-19%20Telehealth%20Informed%20Consent%20Form.png)
Covid-19 Telehealth Informed Consent Form
Covid-19 Telehealth Informed Consent FormRead More
![Event Occurrence Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Event%20Occurrence%20Form.png?width=300&name=Event%20Occurrence%20Form.png)
Event Occurrence Form
Event Occurrence FormRead More
![Florida Consent for Pelvic Exams Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Florida%20Consent%20for%20Pelvic%20Exams%20Form.png?width=300&name=Florida%20Consent%20for%20Pelvic%20Exams%20Form.png)
Florida Consent for Pelvic Exams Form
Florida Consent for Pelvic Exams FormRead More
![Informed Consent Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Informed%20Consent%20Form%20.png?width=300&name=Informed%20Consent%20Form%20.png)
Informed Consent Form
Informed Consent Form Read More
![Dental Informed Consent Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Dental%20Informed%20Consent%20Form%20.png?width=300&name=Dental%20Informed%20Consent%20Form%20.png)
Informed Consent Form - Dental
Informed Consent Form - DentalRead More
![Telehealth Informed Consent Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Telehealth%20Informed%20Consent%20Form%20.png?width=300&name=Telehealth%20Informed%20Consent%20Form%20.png)
Informed Consent Form - Telehealth
Informed Consent Form - TelehealthRead More
![Patient Medication Education Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Patient%20Medication%20Education%20Form.png?width=300&name=Patient%20Medication%20Education%20Form.png)
Medication Education for Patients Form
Medication Education for Patients FormRead More
![Medication Refill Log](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Medication%20Refill%20Log.png?width=300&name=Medication%20Refill%20Log.png)
Medication Refill Log
Medication Refill LogRead More
![Medcation Refill Protocol Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Medcation%20Refill%20Protocol%20Form.png?width=300&name=Medcation%20Refill%20Protocol%20Form.png)
Medication Refill Protocol Form
Medication Refill Protocol FormRead More
![Notice of Inappropriate Behavior Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Notice%20of%20Inappropriate%20Behavior%20Form.png?width=300&name=Notice%20of%20Inappropriate%20Behavior%20Form.png)
Notice of Inappropriate Behavior Form
Notice of Inappropriate Behavior FormRead More
![Authorization to Release Medical Information Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Authorization%20to%20Release%20Medical%20Information%20Form.png?width=300&name=Authorization%20to%20Release%20Medical%20Information%20Form.png)
Patient Authorization to Release Medical Information Form
Patient Authorization to Release Medical Information FormRead More
![Patient Behavior Agreement Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Patient%20Behavior%20Agreement%20Form.png?width=300&name=Patient%20Behavior%20Agreement%20Form.png)
Patient Behavior Agreement Form
Patient Behavior Agreement FormRead More
![Patient Complaint Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Patient%20Complaint%20Form%20.png?width=300&name=Patient%20Complaint%20Form%20.png)
Patient Complaint Form
Patient Complaint Form Read More
![Patient Request to Amend the Medical Record Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Patient%20Request%20to%20Amend%20the%20Medical%20Record%20Form.png?width=300&name=Patient%20Request%20to%20Amend%20the%20Medical%20Record%20Form.png)
Patient Request to Amend the Medical Record Form
Patient Request to Amend the Medical Record FormRead More
![Refusal of Treatment Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Refusal%20of%20Treatment%20Form.png?width=300&name=Refusal%20of%20Treatment%20Form.png)
Refusal of Treatment Form
Refusal of Treatment FormRead More
![Suggested Topics for Policy and Procedure Manuals](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Suggested%20Topics%20for%20Policy%20and%20Procedure%20Manuals.png?width=300&name=Suggested%20Topics%20for%20Policy%20and%20Procedure%20Manuals.png)
Suggested Topics for Policy and Procedure Manuals
Suggested Topics for Policy and Procedure ManualsRead More
![Diagnostic Test and Referral Tracking Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Diagnostic%20Test%20and%20Referral%20Tracking%20Form%20.png?width=300&name=Diagnostic%20Test%20and%20Referral%20Tracking%20Form%20.png)
Tracking and Follow-Up Log
Tracking and Follow-Up LogRead More
![Telephone Triage Guideline](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Telephone%20Triage%20Guideline.png?width=300&name=Telephone%20Triage%20Guideline.png)
Telephone Triage Guideline
Telephone Triage GuidelineRead More
![Observation and Precautions Form](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Observation%20and%20Precautions%20Form%20.png?width=300&name=Observation%20and%20Precautions%20Form%20.png)
Observation and Precautions Form
Observation and Precautions Form Read More
![Closing a Practice Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Closing%20a%20Practice%20Checklist.png?width=300&name=Closing%20a%20Practice%20Checklist.png)
Closing a Practice Checklist
Closing a Practice ChecklistRead More
![Communication Skills Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Communication%20Skills%20Checklist.png?width=300&name=Communication%20Skills%20Checklist.png)
Communication Skills Checklist
Communication Skills ChecklistRead More
![Dental Sedation Anesthia Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Dental%20Sedation%20Anesthia%20Checklist.png?width=300&name=Dental%20Sedation%20Anesthia%20Checklist.png)
Dental Sedation Anesthesia Checklist
Dental Sedation Anesthesia ChecklistRead More
![Emergency Department Behavioral Health Risk Assessment Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Emergency%20Department%20Behavioral%20Health%20Risk%20Assessment%20Checklist.png?width=300&name=Emergency%20Department%20Behavioral%20Health%20Risk%20Assessment%20Checklist.png)
Emergency Department Behavioral Health Risk Assessment Checklist
Emergency Department Behavioral Health Risk Assessment ChecklistRead More
![Unlicensed Employee Skills Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Unlicensed%20Employee%20Skills%20Checklist.png?width=300&name=Unlicensed%20Employee%20Skills%20Checklist.png)
Employee (Unlicensed) Skills Checklist
Employee (Unlicensed) Skills ChecklistRead More
![Licensed Emlpoyee Skills Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Licensed%20Emlpoyee%20Skills%20Checklist.png?width=300&name=Licensed%20Emlpoyee%20Skills%20Checklist.png)
Employee (Licensed) Skills Checklist
Employee (Licensed) Skills ChecklistRead More
![Informed Consent Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Informed%20Consent%20Checklist.png?width=300&name=Informed%20Consent%20Checklist.png)
Informed Consent Checklist
Informed Consent ChecklistRead More
![Dental Informed Consent Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Dental%20Informed%20Consent%20Checklist.png?width=300&name=Dental%20Informed%20Consent%20Checklist.png)
Informed Consent (Dental) Checklist
Informed Consent (Dental) ChecklistRead More
![Organizational Suicide Risk Assessment Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Organizational%20Suicide%20Risk%20Assessment%20Checklist.png?width=300&name=Organizational%20Suicide%20Risk%20Assessment%20Checklist.png)
Organizational Suicide Risk Assessment Checklist
Organizational Suicide Risk Assessment ChecklistRead More
![Recording Conversations in the Office Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Recording%20Conversations%20in%20the%20Office%20Checklist.png?width=300&name=Recording%20Conversations%20in%20the%20Office%20Checklist.png)
Recording Conversations in the Office Checklist
Recording Conversations in the Office ChecklistRead More
![Senior Care Huricanne Preparedness Checklist](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Senior%20Care%20Huricanne%20Preparedness%20Checklist.png?width=300&name=Senior%20Care%20Huricanne%20Preparedness%20Checklist.png)
Senior Care Hurricane Preparedness Checklist
Senior Care Hurricane Preparedness ChecklistRead More
![Sample Patient Notification When Closing a Practice Letter](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Sample%20Patient%20Notification%20When%20Closing%20a%20Practice%20Letter.png?width=300&name=Sample%20Patient%20Notification%20When%20Closing%20a%20Practice%20Letter.png)
Sample Patient Notification When Closing a Practice Letter
Sample Patient Notification When Closing a Practice LetterRead More
![Sample Withdrawal From Care or Termination Letter](https://508142.fs1.hubspotusercontent-na1.net/hub/508142/hubfs/Risk%20Management%20Website/Sample%20Forms%2c%20Checklists%2c%20Letters/Sample%20Withdrawal%20From%20Care%20or%20Termination%20Letter.png?width=300&name=Sample%20Withdrawal%20From%20Care%20or%20Termination%20Letter.png)
Sample Withdrawal From Care or Termination Letter
Sample Withdrawal From Care or Termination LetterRead More