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PHONE: 844-223-9648E-MAIL: RiskAdvisor@ProAssurance.com

Consultation
Assessment
Seminars
Education
Publications

PHONE: 844-223-9648E-MAIL: RiskAdvisor@ProAssurance.com

Sample Forms, Checklists and Letters

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

Against Medical Advice Discharge Form

Against Medical Advice Discharge Form Read More

Against Medical Advice Guidelines

Against Medical Advice Guidelines

Against Medical Advice GuidelinesRead More

Against Medical Advice Physician Documentation Checklist

Against Medical Advice Physician Documentation Checklist

Against Medical Advice Physician Documentation ChecklistRead More

Chain of Command Flowchart

Chain of Command Flowchart

Chain of Command FlowchartRead More

Chain of Command Policy Form

Chain of Command Policy Form

Chain of Command Policy Form Read More

Confidentiality Agreement Form

Confidentiality Agreement Form

Confidentiality Agreement FormRead More

Covid-19 Acknowledgement for Medical Practices

Covid-19 Acknowledgement for Medical Practices

Covid-19 Acknowledgement for Medical PracticesRead More

Covid-19 Telehealth Informed Consent Form

Covid-19 Telehealth Informed Consent Form

Covid-19 Telehealth Informed Consent FormRead More

Event Occurrence Form

Event Occurrence Form

Event Occurrence FormRead More

Florida Consent for Pelvic Exams Form

Florida Consent for Pelvic Exams Form

Florida Consent for Pelvic Exams FormRead More

Informed Consent Form

Informed Consent Form

Informed Consent Form Read More

Dental Informed Consent Form

Informed Consent Form - Dental

Informed Consent Form - DentalRead More

Telehealth Informed Consent Form

Informed Consent Form - Telehealth

Informed Consent Form - TelehealthRead More

Patient Medication Education Form

Medication Education for Patients Form

Medication Education for Patients FormRead More

Medication Refill Log

Medication Refill Log

Medication Refill LogRead More

Medcation Refill Protocol Form

Medication Refill Protocol Form

Medication Refill Protocol FormRead More

Notice of Inappropriate Behavior Form

Notice of Inappropriate Behavior Form

Notice of Inappropriate Behavior FormRead More

Authorization to Release Medical Information Form

Patient Authorization to Release Medical Information Form

Patient Authorization to Release Medical Information FormRead More

Patient Behavior Agreement Form

Patient Behavior Agreement Form

Patient Behavior Agreement FormRead More

Patient Complaint Form

Patient Complaint Form

Patient Complaint Form Read More

Patient Request to Amend the Medical Record Form

Patient Request to Amend the Medical Record Form

Patient Request to Amend the Medical Record FormRead More

Refusal of Treatment Form

Refusal of Treatment Form

Refusal of Treatment FormRead More

Suggested Topics for Policy and Procedure Manuals

Suggested Topics for Policy and Procedure Manuals

Suggested Topics for Policy and Procedure ManualsRead More

Diagnostic Test and Referral Tracking Form

Tracking and Follow-Up Log

Tracking and Follow-Up LogRead More

Telephone Triage Guideline

Telephone Triage Guideline

Telephone Triage GuidelineRead More

Observation and Precautions Form

Observation and Precautions Form

Observation and Precautions Form Read More

Closing a Practice Checklist

Closing a Practice Checklist

Closing a Practice ChecklistRead More

Communication Skills Checklist

Communication Skills Checklist

Communication Skills ChecklistRead More

Dental Sedation Anesthia Checklist

Dental Sedation Anesthesia Checklist

Dental Sedation Anesthesia ChecklistRead More

Emergency Department Behavioral Health Risk Assessment Checklist

Emergency Department Behavioral Health Risk Assessment Checklist

Emergency Department Behavioral Health Risk Assessment ChecklistRead More

Unlicensed Employee Skills Checklist

Employee (Unlicensed) Skills Checklist

Employee (Unlicensed) Skills ChecklistRead More

Licensed Emlpoyee Skills Checklist

Employee (Licensed) Skills Checklist

Employee (Licensed) Skills ChecklistRead More

Informed Consent Checklist

Informed Consent Checklist

Informed Consent ChecklistRead More

Dental Informed Consent Checklist

Informed Consent (Dental) Checklist

Informed Consent (Dental) ChecklistRead More

Organizational Suicide Risk Assessment Checklist

Organizational Suicide Risk Assessment Checklist

Organizational Suicide Risk Assessment ChecklistRead More

Recording Conversations in the Office Checklist

Recording Conversations in the Office Checklist

Recording Conversations in the Office ChecklistRead More

Senior Care Huricanne Preparedness Checklist

Senior Care Hurricane Preparedness Checklist

Senior Care Hurricane Preparedness ChecklistRead More

Sample Patient Notification When Closing a Practice Letter

Sample Patient Notification When Closing a Practice Letter

Sample Patient Notification When Closing a Practice LetterRead More

Sample Withdrawal From Care or Termination Letter

Sample Withdrawal From Care or Termination Letter

Sample Withdrawal From Care or Termination LetterRead More

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