Available on

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

Health Care & Social Services mobile forms and apps for your team

Convert your inefficient paper Hipaa and other forms to mobile versions with GoCanvas.

Want to learn more about GoCanvas?

Request a Demo

Take a Tour

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.'}}

{{data.title}}

Included Fields

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

I give consent to _______ for the use and disclosure of my Protected Health Information (PHI) for...
Home Address (Street, City, State, Zip):
Work Address (Street, City, State, Zip):
Home Phone:
Work Phone:
Cell Phone:
Email:
Marketing: Occasionally we send out newsletters, announcements and special occasion cards.
I have received a copy of the Privacy Policies Notice.
Signature:
Date:
Type Name (Client or Personal Representative):
Relationship to Client and Description of Representative’s Authority:
...and More!