Confidential Patient Health Record for Chiropractic Treatment

Create an office Safety Plan Policy and Incident Occurrence Report with this downloadable template for a chiropractic clinic.

• This template includes:
  • the procedure for appointing safety officers,
  • maintenance of required health and safety certification,
  • emergency evacuation procedures,
  • emergency equipment,
  • incident reporting, and a sample Incident Occurrence Report Form.
• This Chiropractic Office Safety Plan template can be easily customized for your unique business needs.

Chiropractors, obtain a general authorization from a patient with this downloadable Chiropractic Patient Blanket Authorization Form.

• When the patient completes the form, he / she is giving a general 'blanket' direction to any and all medical, paramedical and healthcare service providers.
• The patient authorizes these service providers to release to the chiropractor whatever information they may have on file with respect to injuries the patient has sustained and the treatment or care provided.
• The chiropractor is authorized to use this information for treatment purposes.
• This form is available in MS Word format and can be easily edited and customized to fit your business needs.

Bring an associate into your chiropractic practice with this template Chiropractor Associate Contract. Provisions of the agreement include:

• Facilities and services to be provided by the chiropractic clinic to the associate;
• Number of hours the associate is expected to work;
• Billings and collections procedures;
• Ownership of and responsibility for patient files;
• The associate will have first right of refusal to buy the chiropractic clinic if the owner decides to sell.

The Chiropractor Associate Contract is provided in MS Word format, and is fully editable to fit your exact circumstances.

Chiropractors can refer a patient to a doctor with this free Physician Referral Form.

• The Referral Form would be used to refer a chiropractic patient to a new doctor in circumstances where the chiropractor discovers a medical condition that should be treated by a physician.
• The form has sections for pertinent findings and recommendations.
• This form can be filled in on the computer or device, or used as a pre-printed form to be filled in by hand.
• Available in MS Word format.