Home Health Admission Consent

Form Template

Home health and outpatient care is a growing industry that demands competent and compassion nursing and scrupulous record-keeping.

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This HIPAA compliant electronic assessment and written consent form makes the "paperwork" process easy and facilitates a smooth, efficient informed consent process. This is an intake form template that states the medical treatment, nursing care plan and requires a signature from the patient or the legally authorized representative. This template can be easily customized to meet your agency's specific needs and requirements using GoCanvas' simple 'drag and drop' tool.

The home health admission forms is designed to cover a full array of health services such as physical therapy, skilled nursing care, health and hospice service, post-hospital out-patient care and at-home assisted living. It can be customized to include medical history and laws and regulations regarding managed care. And your company may adjust the terms and conditions of this template app to meet long-term care criteria and goals.

All medical records are securely saved in the GoCanvas Cloud. Use this app's reporting feature to export convenient PDFs that can be printed or emailed if they need to be sent to home health care providers, family members, or other health professionals. This app can be downloaded to an iPhone, iPad, or Android device.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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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

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