Practis Forms
We have pulled together a few of the more common medical office forms utilized by medical practices. It is recommended that for some documents, you review them with legal counsel prior to use.
These document templates are primarily in Adobe (pdf) format. You may download Adobe Reader for free at www.adobe.com.
Insurance Forms
New Patient FormsCredentialing Forms
Electronic CommunicationProvided by the Monroe County Medical Society
- Electronic Mailing List Policy
- Listserv Sample Welcome Message
- Patient Internet Survey
- Guidelines for Patient Practice Email
- Web Site Privacy Policy
- Online Communications Informed Consent
- Internet, Email & Internet Usage Policy
- Sample RFP for an EMR
- Powerpoint Presentation Templates for the Medical Professional [ppt]
- Reminder Letter
- Past Due Collection Letter
- Final Notice Letter
- Returned Check Letter
- Termination of Care Letter
- Authorization of Release of Information
- Consent to Treat Form
- Financial Policy
- Surgery Scheduling Form
- Health Care Proxy Form - NYSDOH
- School Health Information Release Form (MCMS)
- School Health Appraisal Form (MCMS)
- Patient Glossary of Billing Terms (Patient Friendly Billing Project)
- Refusal to vaccinate form (AAP)
- Bureau of Controlled Substances Forms
- NYS Prescription Order Form
HIPAA Forms
- Release of Records Letter
- Model Business Associate Agreement
- Consent form for Interpreter
- Request to Access PHI Log
- HIPAA Document Templates, Forms and Checklists
- HIPAA Transaction & Code Set Compliant Form
Application Forms
- NYS License Application
- Medicare Provider Enrollment Application
- EMC Forms
- Authorization Agreement for EFT
- Addition of Provider to Billing Form
- CMS Forms
PLEASE NOTE: Information is provided as a service to our visitors. Practis takes no responsibility for it's content. It is provided with the understanding that Practis is not engaged in rendering legal, accounting, or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought. Links and information are provided as a service to our visitors. Practis takes no responsibility for their content nor connectivity.