Secure Forms Examples

If you are a Nursing Home, think about the time saved around admissions and authorizations

If you are an LTC Pharmacy, think about the time saved for a prior authorization

If you are a Physician, send forms to new patients prior to their appointments

Forms AdmissionsThe Mediprocity secure form template configuration is customizable and HIPAA compliant. Any of your current forms can be converted into a secure digital form. Here is an example of an admissions department using Mediprocity secure forms with a resident and family members upon admissions.

How do they work?
•    Build your custom template from any form you desire
•    Send the link via email, text, or place a button on your website
•    Users click the link, complete the form and hit submit
•    Receive a notification via Mediprocity messaging taht your form is ready
•    Your entire team can get a copy of the completed form
•    Forms are easily converted to a PDF or Database

For longer forms add our 'Save & Return' button!

Is it legal?
Yes, not only is it legal binding document but is also one of the most secure ways to transfer protected health information – in a full encrypted transit and rest system. We also provide you with a custom legal box which allows your legal team to add in language that your users accept as a terms and conditions.  Mediprocity can even provide you a legal template to help you get started.

Here are some examples:

Nursing Home Admission Example

Advanced Directives Example

Simple Form Example


Save time and remain compliant with Mediprocity Secure Forms