Medical Forms, Templates, and Manuals in Word

You can easily manipulate our forms; add your own clinic’s name, letterhead, photos, logo … whatever you want! We are also glad to help you with any design or formatting questions. You can always contact us for personal attention. We specialize in creating forms for medical clinics and have been doing so for several years. We can also make personalized forms just for you or edit and format your existing forms. Just e-mail us for more information!

Form # Form Title Price Buy Now
GENERAL MEDICAL FORMS (OUR BEST SELLERS)
PACKAGE SPECIAL

Package of our 46 most popular medical forms for general clinic use. These are Word documents, so you can personalize and make changes to them all you want. (See list here.)

$199.00 FOR ALL
FIW-M1

HIPAA Form (General Form)

$7.99
FIW-M2

Medical History and Examination Form (our most popular medical form!) –here is a sample PDF

$7.99
FIW-M3A

Medical Chart Form (Progress Notes for Clinic Use)

$7.99
FIW-M3B

Phone Call Record & Follow-up Progress Notes Form

$7.99
FIW-M3C

Patient Sign In and Physician Notes (1 page)

$7.99
FIW-M4A

Pain Questionnaire Intake Form (2 pages)

$12.99
FIW-M3D

Certificate for Return to Work

$7.99
FIW-M4

Medical Exam Form (for chart)

$7.99
FIW-M5

School Sports Participation – Physician’s Sign-off Form

$7.99
FIW-M6

Standard Patient Information Form

$7.99
FIW-M7

Patient Consent Form (see more below: MW 22A-C)

$7.99
FIW-M8

Billing Overview Statement

$7.99
FIW-M9

Consent to Treat a Minor

$7.99
FIW-M10

HIPAA Policy Overview

$7.99
FIW-M11

Permission to Release Information

$7.99
IW-M12

Privacy Practices

$7.99
FIW-M13

Counseling Goals & History Form $12.99 (4 pages)

$12.99
FIW-M14

Medical Directive Form (Power of Attorney)

$7.99
FIW-M15A

Authorization to Disclose Medical Information Form

$7.99
FIW-M15B

Authorization to Release Medical Records Form (for use by individual to a clinic or hospital, or for use by a clinic)

$7.99
FIW-M16

Chart Record Form (Medical History)

$7.99
FIW-M17

Request to Review Medical Records

$7.99
FIW-M18

Living Will

$7.99
FIW-M19

Notice of Privacy Policy

$7.99
FIW-M20

Patient Registration Form (see sample PDF here)

$7.99
FIW-M22A

NOTICE OF PRIVACY, CONSENT, AND HIPAA (Patient Signs – 1 page)

7.99
FIW-M22B

Patient Consent for Care

$7.99
FIW-M22C

Consent for Medical/Surgical Care/Emergency Treatment for Child

$7.99
FIW-M23

Patient Consent for Disclosure of Protected Health Information (PDF) (new requirement for HIPAA compliance)

$7.99
FIW-M24

Records Transfer Consent Form

$7.99
FIW-M25

Minor Consent to Treatment

$7.99
FIW-M26

Treatment of Minors Policy

$7.99
FIW-M27

State of Alaska Consent for HIV Testing (PDF)

$7.99
FIW-M28

Standard Medical Invoice (1 page)

$7.99
FIW-M28A

Orthopedic Appointment Codes Form (1 page)

$12.99
FIW-M22D

HIPAA Business Associate Agreement

$7.99
FIW-M152

Annual Health Update Form

$12.99
FIW-M155

Immunization History Form

$7.99
FIW-M156

Vaccine Consent Form (Vaccination Consent Form) (1 page)

$7.99
EMERGENCY FORMS
FIW-M29

Emergency Consent for Emergency Treatment (Child)

$7.99
FIW-M30

Emergency Information for Children with Special Needs

$7.99

HEALTH AND SAFETY FORMS
FIW-M31

Annual Safety Performance Appraisal

$7.99

FIW-M32

Checklist for Selection of New Employees

$7.99
FIW-M33

Incident Report Form

$7.99
FIW-M34

Safety Meeting Attendance Form

$7.99
FIW-M35

Workers Compensation Case Notes

$7.99
Health Insurance Forms
CMS 1500

Health Insurance Claim Form (CMS) (complete form; does not print to preprinted forms)

$12.99
CMS 1450 (or HCFA 1450)

UB-92 MEDICARE UNIFORM INSTITUTIONAL PROVIDER BILL

$12.99

CMS Forms

For all CMS forms, please go to our CMS pages by clicking here.

Inspection Forms
FIW-M38

Drill Site Safety Inspection

$7.99
FIW-M39

Drilling Equipment Inspection

$7.99
FIW-M40

Pre-Shift Drill Rig and Site Inspection

$7.99
FIW-M41

Pre-Shift Vehicle Inspection

$7.99
FIW-M42

Shop Safety Inspection Form

$7.99
Medical Examination Forms
FIW-M2

Medical History and Examination Form (our most popular medical form!)

$7.99
FIW-M43

Annual Competency Assessment – send PDF of the form you need for an estimate

FIW-M44A

Certificate of Child Health Examination (simple form for day cares and preschools)

$7.99
FIW-M44B

Certificate of Child Health Examination (Illinois form –see link here)

$18.50
FIW-M45

Checklist for Competency Evaluation

$7.99
FIW-M47

Driver Examination Form

$7.99
FIW-M48

High School Pre-Participation Health Examination

$7.99
FIW-M52

Pre-Employment Medical Assessment

$7.99
FIW-M53

Restricted Duties Assessment

$7.99
Medical History and Exam Forms
FIW-M2

Medical History and Examination Form (our most popular medical form!)

$7.99
FIW-M54

Adolescent Medical History Form

$7.99
FIW-M55

Adolescent Medical History (Parent-Guardian) Form

$7.99
FIW-M56

Adult History – Psychiatric Clinic

$7.99
FIW-M57

Medical History Form – Gynecological/Women’s Concerns

$7.99
FIW-M58

Child & Adolescent History – Psychiatric Clinic

$7.99
FIW-M59

Medical History and Examination Form

$7.99
FIW-M61

Medical History Form – Child

$7.99
FIW-M62

Patient Information – Psychiatric Clinic

$7.99
FIW-M63

Pediatric Health History Form

$7.99
FIW-M64

Personal Health & Medical Record

$7.99
FIW-M66

Standard Medical History and Examination (federal form)

$7.99
Questionnaires
FIW-M67

Determine Your Nutritional Health

$7.99
FIW-M68

Diabetes Questionnaire

$7.99
FIW-M69

Pre-Employment Back Strength and Flexibility – not currently available; please send sample or pdf for us to make in Word

Notices, Requests, and Release Forms
FIW-M70

Authorization for Release of Health Information (HIPAA)

$7.99
FIW-M71

Advance Health Care Directive

$7.99
FIW-M73

Medical Treatment Referral

$7.99
FIW-M75

Request for Access to Medical Records

$7.99
FIW-M76

Request for Release of Information

$7.99
FIW-M77

Travel Medical Form

$7.99
FIW-M78

Travel Release Form for Schools

$7.99

Return to Work Forms

FIW-M79

Certificate to Return to Work

$7.99
FIW-M80

Transitional Return to Work Agreement

$7.99
CHILDREN AND ADOLESCENT FORMS
FIW-M81

Adolescent Medical History Form

$7.99
FIW-M82

Adolescent Medical History (Parent-Guardian) Form

$7.99
FIW-M83

Child & Adolescent History – Psychiatric Clinic

$7.99
FIW-M84

School District Activities Form (School Physicals)

$7.99
FIW-M85

School Physical Information Handout

$7.99
FIW-M86

Schools Sports & Activities Registration Form

$7.99
FIW-M87

Pediatric Health History Form

$7.99
FIW-M88

Request for Access to Medical Records – Adolescent Form (request by parent or guardian)

$7.99
FIW-M89

Detailed Adolescent or Child Medical History Form (3 pages)

$7.99
FIW-M89

Adolescent Medical History Form – Addendum – Questions for Parent or Guardian

$7.99
FIW-M90

Certificate of Child Health Form

$7.99
FIW-M91

Travel Release Form for Schools

$7.99
Occupational Medicine Forms
We have many more occupational medicine forms to put up, so if you don’t see what you need, please email us at paypalorder@formsinword.com
FIW-M93

Medical Examination Report for Commercial Driver Fitness Determination (9 pages) – fromU.S. Department of Transportation, includes instructions and certificate

$39
FIW-M94

Return to Work Form

$7.99
FIW-M95

Occupational Services Request Form

$7.99
FIW-M96

Authorization Form

$7.99
FIW-M97

Emergency Follow-up Instruction Sheet for Patients Treated for Work-related Injury or Illness

$7.99
FIW-M98

Privacy Policy

$7.99
FIW-M99

Medical History Form

$7.99
FIW-M100

Financial Policy

$7.99
FIW-M101

Private Communication Request Form

$7.99
FIW-M102

Patient Information Form

$7.99
FIW-M105

Travel Medicine Form

$7.99
FIW-M106

Medical Treatment Authorization – Occupational Medicine

$7.99
FIW-M107

Patient Intake Form

$7.99
FIW-M108

Authorization form for medical and surgical treatment from patient to physician.

$7.99
FIW-M109

Authorization for medical and surgical treatment on behalf of a relative.

$7.99
FIW-M110

Consent to release medical records.

$7.99
FIW-M111

Power of Attorney to give another person decision making power to authorize all medical and surgical procedures.

$7.99
FIW-M112

Medical Examiners Certificate for Commercial Driver Fitness Determination

$39
FIW-M113

Info. Request Form

$7.99
FIW-M151 – QLFT Form

OSHA Respirator Annual Fit Test Form (Qualitative Fit Test (QLFT) Form)

$7.99
FIW-M153

Accident investigation Form – Includes 3 forms in one document: Employee’s Report of Injury and Supervisor’s Accident Investigation and Accident Witness Statement

$12.99
FIW-M154

Blood Borne Pathogen Incident Report Form

$12.99
FIW-M152

Annual Health Update Form – 1 page, mainly regarding vaccinations

$7.99
FIW-M152-A

Annual Health Update Form – 1 page, for K-12, list of current illnesses and medications

$7.99
FIW-M155

Immunization History Form

$7.99
FIW-M156

Vaccine Consent Form (Vaccination Consent Form) (1 page)

$7.99

For more occupational forms, just email us with the form you need.

Surgery Forms & Emergency Forms
FIW-M113A

General Surgery Consent Form (General)

$7.99
FIW-M-113B

Child and Adolescent Surgery Consent Form

$7.99
FIW-M-113C

Consent Form for Plastic Surgery – Generic

$7.99
FIW-M-113D

Emergency Room Consent Form – Generic

$7.99
Orthopedic Forms
FIW-M-120

Chart for 6-week Follow-up

$7.99
FIW-M-121

Six-Week Follow-up Primary Total Joint Arthroplasty (TJA)

$7.99
FIW-M-122

Progress Notes – 1 page

$7.99
FIW-M-123

Progress Notes – 2 page

$7.99
FIW-M-124

Oxford Hip Score

$7.99
FIW-M-125

Chart for Pre-op cardiovascular (CV)

$7.99
FIW-M-126

12-Week Follow-up Primary Total Joint Arthroplasty (TJA)

$7.99
FIW-M-127

and many more to come; just send us your pdf or scan or title of the form you want, and we will let you know if we can make it in Word!

Thoracic and Cardiovascular Surgery Forms
FIW-M-128

Cardiavascular and thoracic Surgery Clinic Forms PACKAGE: Includes: Patient Questionnaire (3 pages), Follow-up, Case History (2 pages), Patient Intake Form, Authorization for Disclosure and Transfer of Medical Information & Records, and Insurace Assignment/Benefits and Release Form (9 pages total)

$45
Medical Clinic & Hospital Manuals & Templates in Microsoft Word
Save yourself hours of time by purchasing our manuals and inserting your clinic information. These are Word documents and are easy to use. We have no locked features on them, so you can change, copy, add to, delete, and manipulate as needed!
FIW-M114

Employee Manual 50 pages, general employee manual; easily search and replace with your clinic’s name and make changes as needed $99

$25.50
FIW-M115

Proposal Template Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, reference page, appendix, covers, and more. Instructions included for writing your proposal.

$29.00
FIW-M116

Report Template Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, reference page, appendix, covers, and more. Instructions included for writing your report.

$29.00
FIW-M117

Statement of Qualifications (SOQ) Template for Medical Clinics Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, covers, and more. Instructions included for writing your SOQ.

$25.50
Government Forms
Medical We already have created numerous federal and state government medical forms in Word, and we can create local forms as well. Just purchase below or email us with your needs!
CMS & HCFA Forms (Centers for Medicare & Medicaid Services) including MEDICAL NECESSITY FORMS (our most popular medical forms!) SEE our CMS page.
U.S.
GOVERNMENT FORMS (SF Medical Forms click here, DOT Medical Forms click here, and OF Medical Form click here)

OTHER FORMS

FIW-M-NPN

Nursing Clinical Progress Note

$18.50

OPTHAMOLOGIST FORMS

Eye Chart

Eye Chart with Graphics; 1 page

$7.99

Just email us with your request!

FOOT CLINIC OR PODIATRIST FORMS

FIW-MFC-1

Foot Clinic Billing Codes Form

$29.00
FIW-MFC-2

Foot Clinic Patient History and Exam Form (2 pages including pictures)

$15.00
FIW-MFC-3

Foot Clinic Patient Fill-in Form – 1 page – in Spanish

$15.00