Medical Clinic Forms in Microsoft Word

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.