Patient Rights Templates

This Form is used for obtaining facility information in the state of Iowa.

This form is used for authorizing the release of medical information in the state of Texas.

This form is used for obtaining informed consent from pregnant individuals with opioid/opiate use disorder in Texas who are seeking treatment.

This form is used for obtaining consent from patients in Texas for patient navigation services.

This form is used for notifying clients about the privacy practices for their medical information in Washington state. It is available in both English and Amharic languages.

This document provides information about the privacy practices regarding client medical information in Washington. It is available in English and Mongolian.

This document is for clients in Washington and provides important information about the privacy practices regarding their medical information. It is available in both English and Somali languages.

This type of document is a Notice of Privacy Practices for client medical information in Washington. It is available in both English and Serbo-Croatian languages.

This document outlines the way in which a patient's Protected Health Information (PHI) may be disclosed to third parties.

This form is used to authorize the release of personal information in the state of Maryland.

This form is used to request the Woman's Right to Know Patient Education Handbook in North Carolina. It provides information and resources related to women's reproductive health and rights.

This document is used for expressing your healthcare wishes in Alaska. It allows you to designate a healthcare power of attorney and specify your healthcare preferences in case you are unable to make decisions for yourself.

This form is used for granting permission to healthcare providers to release your medical records to a third party, such as another healthcare provider or an insurance company.

This document is used for obtaining consent for treatment for involuntary patients in British Columbia, Canada.

This form is used in British Columbia, Canada to notify health care providers that a patient under the age of 16 has been admitted by a parent or guardian. The form informs the parent or guardian of the patient's rights under the Mental Health Act.

This document is an Advance Directive form specific to the state of Kentucky. It allows individuals to communicate their healthcare wishes in advance, in the event that they become unable to make decisions for themselves.

This form is used for authorizing the disclosure of protected information in Kentucky.

This document allows a Mississippi resident to request access to their own protected health information.

This form is used for filing a petition for involuntary commitment in North Dakota.

This Form is used for providing a notice of emergency detention in North Dakota. It is used when a person is deemed in need of immediate care and treatment for mental illness or chemical dependency.

This Form is used for filing complaints against facility administrators in South Dakota's Board of Nursing.

This type of document is for obtaining accreditation for rehabilitative behavioral health services in South Carolina.

The purpose of this document is to provide individuals or entities with legal consent from an individual for information disclosure.

This form is used for ordering the administration of authorized involuntary treatment, specifically Electroconvulsive Therapy (ECT), in the state of Illinois.

This document outlines the privacy practices and policies followed by healthcare providers in New York City. It explains how personal health information is protected and used by healthcare providers.

This is a document that individuals can use when they would like to appeal a decision about a medical necessity by their insurance company.

This Form is used for requesting an appeal for a healthcare decision in Arizona.

This document is used for informing individuals about their right to refuse medical treatment or procedures in the state of Arkansas.

This form is used for filing complaints related to emergency medical systems in the state of New Mexico.