Patient Rights Templates

This form is used for requesting a due process hearing for continued involuntary treatment in the state of Georgia, United States.

This document provides information on how your personal health information is protected and used by healthcare providers in Georgia. It outlines your privacy rights and how you can control the use of your data.

This form is used for granting permission to release personal information in the state of Georgia, United States.

This document is used for denying or disputing privacy practices in the state of Georgia, United States.

This form is used for reporting disagreement with the denial of a request to amend or correct health information under HIPAA regulations in the state of Louisiana.

This form is used for acknowledging receipt of the Notice of Privacy Practices in Massachusetts. It is in Portuguese language.

This document is for residents of Minnesota who want to request an external appeal for a decision made by their health insurance company. It allows you to contest the decision and have it reviewed by an independent third party.

This document is for individuals in Missouri who have not had any contact after sending a referral letter.

This Form is used for patients in Montana who wish to refuse medical treatment. It allows individuals to clearly express their desire to decline medical procedures or interventions.

This form is used for filing a complaint related to the Emergency Medical Systems Program in Nevada.

This type of document is used for creating an Advance Health Care Directive in Newfoundland and Labrador, Canada. It allows individuals to specify their preferences for medical treatment and appoint a substitute decision-maker in case they cannot make decisions for themselves.

This form is used for requesting to rectify information in the Quebec Electronic Health Record (QHR) in Quebec, Canada.

This form is used for releasing electronic records in the state of Ohio.

This document is used for acknowledging the Health Insurance Portability and Accountability Act (HIPAA) in Ohio.

This document provides a comprehensive guide on consent and capacity in Ontario, Canada. It is specifically designed for the Erie St. Clair Community Care Access Centre (CCAC) region. The guide outlines the rights and considerations regarding consent and capacity in healthcare decision making.

This document is used for certifying the good faith in a medical malpractice case filed by the plaintiff in the state of Tennessee.

This legal form encompasses the orders concerning your wishes about your future medical care in the state of Alabama. The document comes into play in the event of severe medical situations in which you are not able to communicate your wishes or make decisions.

Download this Colorado form for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.

This form is used in Idaho as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.

Use this form in the state of Mississippi for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.

These are Missouri-specific written instructions about future medical care should you become unable to make decisions (for example, unconscious or too ill to communicate).

This form is used in Nebraska as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.

This form is used in Texas as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.

This New York-specific form is used as part of the patient's medical records. It determines health care measures to be taken in the event of the patient's severe physical or mental incapacity.

This form is used for granting a family member or friend the right to access protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).

This form is used for acknowledging the receipt of information related to a hysterectomy procedure in the state of Illinois.

This document appoints a person to make health care decisions on your behalf in the state of Arkansas.

This form is used for requesting the release of medical records in the state of Hawaii.

This form is used for the temporary release of an involuntary patient in Yukon, Canada. The form allows for the patient's release under specific conditions and for a fixed period of time.

This Form is used for applying to withhold clinical record in Yukon, Canada.

This form is used for patients undergoing Substance Use Disorder Medication Assisted Treatment in Washington. It outlines the patient's rights and is available in both English and Spanish.

This form is used for filing an appeal and requesting a hearing for an involuntary discharge notice in Illinois.

This Form is used for authorizing the release of medical information under HIPAA in the state of Kentucky.

This document allows the authorized release of psychotherapy notes in Massachusetts.

This form allows patients in Yukon, Canada to exercise their right to be informed about their medical treatments and procedures.