Healthcare Services Forms

Make sure you get paid for medical services rendered to a patient with this Connecticut Doctor's Lien and Patient Consent form.

• Patients should sign this form before you provide treatment.
• The patient authorizes the facility to release medical information about the injury and treatment, for purposes of the injury claim.
• The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien from those proceeds.
• The patient will be personally liable for paying the health care provider's fees if there is no settlement or if it's insufficient to pay the medical bills.
• The patient will notify the medical provider if he/she retains new legal counsel.

Don't wait for settlement to secure repayment of your bills. Do it now with this Connecticut Doctor’s Lien and Patient Consent Form.

Prepare a business plan for a dentist's office with this fully customizable Dental Office Business Plan template.

Why do I need a business plan?

If you are starting up your dental practice, you probably need a startup loan. The purpose of the Business Plan is to obtain startup financing which can be used to buy equipment and supplies, lease office space, and hire staff for the dental office.

What is included in the template?

• A Confidentiality Agreement to protect your proprietary information (financial data, business model, etc.).
• A market analysis and marketing strategy for promoting the dentist’s services.
• A financial model with sample pro formas.
• Instructions in each section to help you complete the document.

Format

The business plan template is available in MS Word format from MegaDox.com. It is totally editable to fit your exact specifications. This template can be used anywhere.

Offer a candidate a house staff position at a hospital in the United States with this Letter of Intent / Employment Offer template.

• The employee must obtain a State medical license or intern and residency license before beginning work.
• The employee must successfully undergo drug and criminal background screening.
• The Medical Center will provide malpractice insurance.
• Health care insurance, life insurance and disability insurance are available through the Center's insurers.
• House staff will be reimbursed for parking fees by means of an annual cash benefit.
• Moonlighting is discouraged but not prohibited. The employee's malpractice insurance does not extend to any outside employment.
• This is a fully editable MS Word document.
• Drafted to be used only in the United States.

Don't be a victim. Read Fighting Back: Every Woman's Guide to Survival and learn how to defend yourself against attackers.

This 66-page self defence guide was written by Helene Crane, a 14-year police force veteran. It will teach you how to stay safe, and practice the author's step-by-step illustrated methods to defend yourself against armed and unarmed attackers:

• Learn how to defend against attacks from the front and from the rear.
• Learn how you can turn everyday objects into defensive weapons.
• Discover ways to deal with the emotional and physical aftermath of an assault.

Fighting Back: Every Woman's Guide to Survival is available in PDF format and can be downloaded to Kindle, Sony Reader or other e-readers.

Make sure injury patients pay their bills by having them sign this Georgia Patient Consent and Medical Lien Agreement.

What is a medical lien?

A medical provider who provides treatment to an accident victim has an irrevocable lien right over any settlement amounts awarded to the patient. A medical lien (also called a doctor's lien) ensures that your bills will be paid from the funds eventually recovered by the patient. 

Why should I use a Medical Lien Agreement?

A Medical Lien Agreement gives medical service providers the flexibility to provide their services without up-front billing, knowing that the lien will be paid from the recovery proceeds.

Under the terms of the Agreement, the patient's attorney is directed to satisfy the medical provider's lien out of the settlement funds. Regardless of the settlement of the claim, the patient will remain personally responsible for paying the fees.

Patient Consent

The patient authorizes the medical practitioner to release any information about the accident or injury being treated, for purposes of the patient's injury claim.

Format and Scope of Use

This is a reusable legal form in MS Word format. Once you've purchased it, you can use it as often as you like. The template can be customized for your specific business needs.

This Patient Consent and Medical Lien Agreement is intended for use only in the State of Georgia.

Do you provide home care workers for assisted living clients? Write up your client contracts with this easy Home Care Provider Agreement.

• Work Schedule. The caregiver will work according to the work schedule that the parties agree to.
• Home Care Services. The caregiver will provide services such as cooking, bathing, driving and other duties that the client cannot perform for himself/herself.
• Probation and Termination. Provisions for termination of the agreement before and after a specified probationary period.
• Vehicle Use and Insurance. If the caregiver will be driving the client, there are optional provisions for use of the client's vehicle and use of the caregiver's vehicle. If the caregiver's vehicle is used, an insurance coverage clause is included.
• Accident Reporting. The caregiver agrees to keep record of any accidents and to report to the company.
• Any party in breach of the agreement shall pay reasonable attorney's fees or costs incurred by the other party.

This USA Home Care Provider Agreement is in MS Word format and is fully editable to fit your particular circumstances. It is intended for use in the United States, but can be adapted for use in other jurisdictions.

Do you treat patients who have been injured by accident or third parties. Have them sign this Illinois Doctor's Lien and Patient Consent Form at the time of treatment.

• The patient gives his/her consent for the treatment and authorizes the medical practitioner to release any information required to conduct the patient's injury claim.
• Regardless of the outcome of the claim, the patient will be personally liable for paying the medical bills.
• The doctor has an irrevocable lien on any settlement or damages awarded to the patient. The patient's lawyer is instructed to satisfy the lien out of the settlement proceeds.
• The patient must give notice if he/she hires a different attorney.
• Intended for use only in the State of Illinois.

Keep Your Nurses and Health Care Professionals for Life is a downloadable 210-page book by Brian Lee, CSP, based on his popular seminars.

• The book delves into the medical profession and gives tips on how to keep our healthcare professionals in Canada and give life back to the profession.
• Discover the 4 imperatives of how to inspire, retain, motivate and empower patient focused nurses and health care professionals.
• Learn more about significant issues such as staff retention, staff empowerment, continuing education and inter-office relationships.
• Keep Your Nurses and Health Care Professionals for Life is a downloadable e-book which is available in PDF format.

Don't gamble with your patient invoices. Have your patients sign this Massachusetts Doctor's Lien and Patient Consent Form at the time treatment is provided.

• The patient consents to treatment and authorizes the facility to release his/her medical information for purposes of the patient's injury claim.
• The patient will be personally liable for paying the medical provider's fees whether or not the claim is successful and damages are awarded.
• The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien out of those proceeds.

You can use this Massachusetts Doctor's Lien and Patient Consent form over and over again. Download it and customize it for your business.

All information collected by a medical office is confidential. Have all of your staff sign this Employee Pledge of Confidentiality.

• In order to comply with privacy laws, all personnel employed in health services positions must pledge in writing to keep all patient information confidential.
• This form is downloadable, editable and easy to use.
• Customize the form by adding your office's logo, and print off copies to use as a hand-out for new employees and practitioners to sign.
• This free form is available in MS Word format.