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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 and manuals and writing proposals & Web sites 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!

All forms are Microsoft Word documents that are completely fillable and easy to use, save, and copy, and we email them directly to you after purchse - usually in just a few minutes!  Our MS Office-certified designers make current, correct, and easy government forms in Word with automatic form fill features. We always do a careful proof of each form to be sure it looks just like the federal form. We are happy to answer questions that you have, and we usually e-mail your document to you right away. The only information we receive from PayPal to contact you is your email address, so if you prefer that we send your form to another e-mail or if you typed it in wrong, e-mail us (forms@formsinword.com) about where to send your form (include your phone number). Thank you for using Forms in Word! Questions? E-mail (fastest way to reach us) or call 907-841-5393 for personalized service!

Form No.
Form Description
Price
Buy Now in Word

GENERAL MEDICAL FORMS (OUR BEST SELLERS)

FIW-M1 HIPAA Form (General Form)
$5.00
FIW-M2 Medical History and Examination Form (our most popular medical form!) - here is a sample PDF
$5.00
FIW-M3A Medical Chart Form (Progress Notes for Clinic Use)
$5.00
FIW-M3B Phone Call Record & Follow-up Progress Notes Form
$5.00
FIW-M3C Patient Sign In and Physician Notes (1 page)
$5.00
FIW-M4A Pain Questionnaire Intake Form (2 pages)
$12.99
FIW-M3D Certificate for Return to Work
$5.00
FIW-M4

Medical Exam Form (for chart)

$5.00

FIW-M5

School Sports Participation - Physician's Sign-off Form

$5.00

FIW-M6

Standard Patient Information Form

$5.00

FIW-M7

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

$5.00

FIW-M8

Billing Overview Statement

$5.00

FIW-M9

Consent to Treat a Minor

$5.00

FIW-M10

HIPAA Policy Overview

$5.00

FIW-M11

Permission to Release Information

$5.00

IW-M12

Privacy Practices

$5.00

FIW-M13

Counseling Goals & History Form $25 (4 pages)

$25.00

FIW-M14

Medical Directive Form (Power of Attorney)

$5.00

FIW-M15A Authorization to Disclose Medical Information Form

$5.00

FIW-M15B

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

$5.00

FIW-M16

Chart Record Form (Medical History)

$5.00

FIW-M17

Request to Review Medical Records

$5.00

FIW-M18

Living Will

$5.00

FIW-M19

Notice of Privacy Policy

$5.00

FIW-M20

Patient Registration Form (see sample PDF here)

$5.00

FIW-M22A NOTICE OF PRIVACY, CONSENT, AND HIPAA (Patient Signs - 1 page)
5.00
FIW-M22B

Patient Consent for Care  

$5.00

FIW-M22C Consent for Medical/Surgical Care/Emergency Treatment for Child
$5.00
FIW-M23

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

$5.00

FIW-M24

Records Transfer Consent Form

$5.00

FIW-M25

Minor Consent to Treatment

$5.00

FIW-M26

Treatment of Minors Policy

$5.00

FIW-M27

State of Alaska Consent for HIV Testing (PDF)

$5.00

FIW-M28 Standard Medical Invoice (1 page)
$5.00
FIW-M28A Orthopedic Appointment Codes Form (1 page)
$10.00
FIW-M22D HIPAA Business Associate Agreement
$5.00

EMERGENCY FORMS

FIW-M29

Emergency Consent for Emergency Treatment (Child)          

$5.00

FIW-M30

Emergency Information for Children with Special Needs

$5.00

HEALTH AND SAFETY FORMS

FIW-M31

Annual Safety Performance Appraisal

$5.00

FIW-M32

Checklist for Selection of New Employees

$5.00

FIW-M33

Incident Report Form

$5.00

FIW-M34

Safety Meeting Attendance Form

$5.00

FIW-M35

Workers Compensation Case Notes

$5.00

Health Insurance Forms

CMS 1500 Health Insurance Claim Form (CMS) (complete form; does not print to preprinted forms)
$14.99

CMS 1450 (or HCFA 1450)

UB-92 MEDICARE UNIFORM INSTITUTIONAL PROVIDER BILL

$14.99

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

Inspection Forms

FIW-M38

Drill Site Safety Inspection

$5.00

FIW-M39

Drilling Equipment Inspection

$5.00

FIW-M40

Pre-Shift Drill Rig and Site Inspection

$5.00

FIW-M41

Pre-Shift Vehicle Inspection

$5.00

FIW-M42

Shop Safety Inspection Form

$5.00

Medical Examination Forms

FIW-M2 Medical History and Examination Form (our most popular medical form!)
$5.00
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)

$5.00

FIW-M44B

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

$39.00

FIW-M45

Checklist for Competency Evaluation

$5.00

FIW-M47

Driver Examination Form

$5.00

FIW-M48

High School Pre-Participation Health Examination

$5.00

FIW-M52

Pre-Employment Medical Assessment

$5.00

FIW-M53

Restricted Duties Assessment

$5.00

Medical History and Exam Forms

FIW-M2 Medical History and Examination Form (our most popular medical form!)
$5.00
FIW-M54

Adolescent Medical History Form

$5.00

FIW-M55

Adolescent Medical History (Parent-Guardian) Form

$5.00

FIW-M56

Adult History – Psychiatric Clinic

$5.00

FIW-M57

Medical History Form – Gynecological/Women's Concerns

$5.00

FIW-M58

Child & Adolescent History – Psychiatric Clinic

$5.00

FIW-M59

Medical History and Examination Form

$5.00

FIW-M61

Medical History Form – Child

$5.00

FIW-M62

Patient Information – Psychiatric Clinic

$5.00

FIW-M63

Pediatric Health History Form

$5.00

FIW-M64

Personal Health & Medical Record

$5.00

FIW-M66

Standard Medical History and Examination (federal form)

$5.00

Questionnaires

FIW-M67

Determine Your Nutritional Health

$5.00

FIW-M68

Diabetes Questionnaire

$5.00

FIW-M69

Pre-Employment Back Strength and Flexibility

$5.00

Notices, Requests, and Release Forms

FIW-M70

Authorization for Release of Health Information (HIPAA)

$5.00

FIW-M71

Advance Health Care Directive

$5.00

FIW-M73

Medical Treatment Referral

$5.00

FIW-M75

Request for Access to Medical Records

$5.00

FIW-M76

Request for Release of Information

$5.00

FIW-M77

Travel Medical Form

$5.00

FIW-M78

Travel Release Form for Schools

$5.00

Return to Work Forms

FIW-M79

Certificate to Return to Work

$5.00

FIW-M80

Transitional Return to Work Agreement

$5.00

CHILDREN AND ADOLESCENT FORMS

FIW-M81

Adolescent Medical History Form

$5.00

FIW-M82

Adolescent Medical History (Parent-Guardian) Form

$5.00

FIW-M83

Child & Adolescent History – Psychiatric Clinic

$5.00

FIW-M84

School District Activities Form (School Physicals)

$5.00

FIW-M85

School Physical Information Handout

$5.00

FIW-M86

Schools Sports & Activities Registration Form

$5.00

FIW-M87

Pediatric Health History Form

$5.00

FIW-M88

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

$5.00

FIW-M89

Detailed Adolescent or Child Medical History Form (3 pages)

$5.00

FIW-M89

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

$5.00

FIW-M90

Certificate of Child Health Form

$5.00

FIW-M91

Travel Release Form for Schools

$5.00

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 forms@formsinword.com

FIW-M93

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

$39

FIW-M94

Return to Work Form

$5.00

FIW-M95

Occupational Services Request Form

$5.00

FIW-M96

Authorization Form

$5.00

FIW-M97

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

$5.00

FIW-M98

Privacy Policy

$5.00

FIW-M99

Medical History Form

$5.00

FIW-M100

Financial Policy

$5.00

FIW-M101

Private Communication Request Form

$5.00

FIW-M102

Patient Information Form

$5.00

FIW-M105

Travel Medicine Form

$5.00

FIW-M106

Medical Treatment Authorization - Occupational Medicine

$5.00

FIW-M107

Patient Intake Form

$5.00

FIW-M108

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

$5.00

FIW-M109

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

$5.00

FIW-M110

Consent to release medical records.

$5.00

FIW-M111

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

$5.00

FIW-M112

Medical Examiners Certificate for Commercial Driver Fitness Determination

$39

FIW-M113

Info. Request Form

$5.00

Surgery Forms & Emergency Forms
FIW-M113A General Surgery Consent Form (General)
$12.99
FIW-M-113B Child and Adolescent Surgery Consent Form
$12.99
FIW-M-113C Consent Form for Plastic Surgery - Generic
$12.99
FIW-M-113D Emergency Room Consent Form - Generic
$12.99
Just email us with the form you need; we have many that we have not added to our site yet! Most cost $15.00 each, and we will send you a PayPal button for the correct form

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

$59

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.

$59

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 Forms click here) or see below:

(Medical Page) SF-93

SF-93 General Patient Information Form (2 pages)

$5.00

(Medical Page) SF 503

SF503 Medical Record - Autopsy Protocol

$5.00

(Medical Page) SF 504

SF504 Medical Record - History

$5.00

(Medical Page) SF 505

SF505 Medical Record - History - Parts 2 and 3

$5.00

(Medical Page) SF 506

SF506 Medical Record - Physical Examination

$5.00

(Medical Page) SF 507

SF507 Medical Record

$5.00

(Medical Page) SF 509

SF509 Medical Record - Progress Report

$5.00

(Medical Page) SF 510

SF510 Medical Record - Nursing Notes

$5.00

(Medical Page) SF 513

SF513 Medical Record - Consultation Sheet

$5.00

(Medical Page) SF 515

SF515 Medical Record - Tissue Examination

$5.00

FIW-M SF526

SF526 Medical Record - Interstitial/Intercavitary Therapy

$5.00

(Medical Page) SF 531

SF531 Medical Record - Anatomical Figure

$5.00

FIW-M SF533

SF533 Medical Record - Prenatal and Pregnancy (11 pages, very detailed, and one of our most popular forms!)

$49 - ON SALE: $29.99

FIW-M SF536

SF536 Medical Record - Pediatric Nursing Notes

$5.00

FIW-M SF551

SF551 Medical Record - Serology

$5.00

FIW-M SF558

SF558 Medical Record - Emergency Care and Treatment

$5.00

FIW-M SF559

SF559 Medical Record - Allergen Extract Prescription - New and Refill

$5.00

FIW-M SF600

SF600 Medical Record - Chronological Record of Medical Care (2 pages)

$15.49

FIW-M SF602

SF602 Medical Record - Serology Record

$5.00

FIW-M SF701

SF701 Activity Security Checklist

$5.00

FIW-M SF702

SF702 Security Container Checksheet

$5.00

FIW-M SF713

SF713 Consent for Access to Records

$5.00

FIW-M OMB I-693

OMB I-693 Medical Examination of Aliens Seeking Adjustment of Status U.S. Department of Justice Immigration and Naturalization Service (10 pages)

$5.00

FIW-M OPM 1530

OPM 1530 Report of Medical Examination of Person Electing Survivor Benefit Under the Civil Service Retirement System

$5.00

DOT & OF MEDICAL FORMS

FIW-M-DOT G 40

DOT Form - Alcohol Testing Appendix G to Part 40—Alcohol Testing Form

$15.49

FIW-M DOT H 40 MIS Form

DOT Form -  Appendix H to Part 40—DOT Drug and Alcohol Testing Management Information System (MIS) Data Collection Form

$15.49

FIW-M OF517

OF517 Medical Record – Anesthesia

$59.00

FIW-M OF522

OF522 Medical Record - Request for Administration of Anesthesia and Performance of Operations and Other Procedures 08/2003

$15.49

FIW-M OF523B

OF523B Medical Record - Authorization for Tissue Donation

$15.49

  OTHER FORMS    
CHS-050 Carlinas HealthCare System Authorization for Release of Health Information

$59.00

DHMH 4345 Maryland Department of Health and Mental Hygiene Peradmission Screening and Resident Review (PASRR) Level I ID Screen for Mental Illness and Mental Retardation or Related Conditon

$39.00

DOL Forms Delineation of Privilege Forms - just email us with the type of DOL form you need, and we will send it or create it for you in Word. If you have a sample or PDF that you prefer we use, just email that as well.

$39.00

For Dentist Office Forms, click here.

Counseling Forms - we haven't put up most of these yet, but we have many of them available in Word. Just email us with your needs, and we'll let you know the price in Word.

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Mailing Address: P.O. Box 230776, Anchorage, AK 99523
Phone: 907-841-5393
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