Agreement to Abstain from Alcohol and Substance Abuse And Consent to Random Testing

Form Template

The "Agreement to Abstain from Alcohol and Substance Abuse And Consent to Random Testing Kidney/Pancreas Transplant Program" is an app to ask the patient approval before an organ transplant.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

Alcohol and substance use or drug abuse can significantly reduce a patient’s chance of a successful organ transplant. Abstinence from substances such as drugs, alcohol and tobacco greatly increases the likelihood of a successful transplant. The Transplant Program requires that its liver transplant recipient have zero alcohol consumption. This convenient app helps filling and storing the forms efficiently , including capturing electronic signatures to ensure all patients are in agreement about the procedure.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
Read More
  • iPhone
  • iPad
  • Android
  • Windows
Read More
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us