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HIPAA Client Consent Form Mobile App

This HIPAA (Health Insurance Portability and Accountability Act) Client Consent mobile app grants users the ability to instantly record pertinent data directly from their smartphones or tablets. Once health care data is captured in the HIPPA patient consent form, the HIPPA data is synched to the GoCanvas Cloud where users can store, analyze and manage the data  according to HIPPA privacy rules in real time for better process optimization. 

Key benefits of this app:

• The mobile app is a must have for all health care providers and professionals

• The app allows users to abide by HIPAA privacy regulations with regards to informed consent, medical records, HIPAA authorization, mental health, and general health information

• The HIPPA patient consent template can be fully customized to fit each users individual health information needs while still being HIPAA compliant

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the HIPAA Client Consent Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    I give consent to _______ for the use and disclosure of my Protected Health Information (PHI) for...

  • Ico multiline

    Home Address (Street, City, State, Zip):

  • Ico textbox

    Work Address (Street, City, State, Zip):

  • Ico integer

    Home Phone:

  • Ico integer

    Work Phone:

  • Ico integer

    Cell Phone:

  • Ico textbox

    Email:

  • Ico checkbox

    Marketing: Occasionally we send out newsletters, announcements and special occasion cards.

  • Ico statictext

    I have received a copy of the Privacy Policies Notice.

  • Ico camera

    Signature:

  • Ico date

    Date:

  • Ico textbox

    Type Name (Client or Personal Representative):

  • Ico textbox

    Relationship to Client and Description of Representative’s Authority:

  • ...and More!

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