Consent Forms - MEDOCS

Internal Medicine EHR

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Consent Forms

Ctrl+K

Patient Kiosk

Share this link or QR code with patients to complete consent forms.

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Consent Form Templates

Name	Type	Version	Status	Last Updated	Actions
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Patient

Time

Type & Status

Reason for Visit

Clinical Notes

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Messages

Location Name *

Address

City

State

ZIP

Phone

Facility NPI

Place of Service

Timezone *

All appointment times will be displayed in this timezone for users at this location.

Set as primary (default) location

Assign to Clinic *

First Name *

Last Name *

Date of Birth *

Gender

SSN

Phone

Email

Address

City

State

ZIP

Provide emergency contact information for the patient. This will be used in case of emergencies.

Contact Name

Relationship

Phone

Alternate Phone

Primary Insurance

Insurance Type

Payer Name

Payer ID

Member ID / Policy Number

Group Number

Cost Sharing

Copay ($)

$

Fixed amount per visit

Coinsurance (%)

%

% patient pays after deductible

Deductible ($)

$

Annual deductible amount

Subscriber Information

Relationship to Patient

Subscriber First Name

Subscriber Last Name

Subscriber DOB

Insurance Verification

Secondary Insurance (Optional)

Insurance Type

Payer Name

Payer ID

Member ID / Policy Number

Group Number

Subscriber Information

Relationship to Patient

Subscriber First Name

Subscriber Last Name

Subscriber DOB

Insurance Verification

Upload patient documents such as insurance cards, ID, referrals, or medical records. All files are encrypted at rest for HIPAA compliance.

Document Category

Description (Optional)

Upload Documents

Drag and drop files here or click to browse

Supported: PDF, JPG, PNG, DOC, XLS, TXT (Max 10MB each)

Uploaded Documents

File Name	Category	Size	Uploaded	Actions

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

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Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

Assign to Clinic *

First Name *

Last Name *

NPI *

Credentials

Specialty

Taxonomy

Email

Phone

License Number

License State

License Expiry

Default Appointment Duration (min)

Profile Color

Active

Work Schedule (Duty Hours)

Set the provider's working hours for each day. Available slots will be generated based on this schedule.

Day	Available	Start Time	End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Provider Signature

Upload a signature image (JPG or PNG) that will be used when signing clinical notes with the {{provider_signature}} placeholder.

No signature uploaded

Upload Signature Image Max 2MB. JPG or PNG format.

User Account (Auto-Created)

A user account will be automatically created for this provider using the email above.

Password *

Required for user account creation

Care Episode Details

Patient

-

Primary Provider

-

Diagnosis

-

-

Status

-

Start

-

End

-

Visits

-

Treatment Plan

Visit Frequency

-

Goals

-

Plan of Care

-

Appointments 0

No appointments

Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

First Name *

Last Name *

Email *

Phone

Role *

Password *

Minimum 8 characters

Provider Association

Link to Provider Select a provider if this user is a clinician account

No Provider

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicEmail}} - Email address

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content

New Patient Portal Invite

Enter the patient's name and email. A new patient record will be created and an invitation will be sent for the patient to complete their registration.

First Name *

Last Name *

Email Address *

Invitation History

Patient	Email	Status	Sent	Actions
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Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

First Name *

Last Name *

Email *

Phone

Role *

Password *

Minimum 8 characters

Provider Association

Link to Provider Select a provider if this user is a clinician account

No Provider

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicEmail}} - Email address

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content