Jotform Health - Medicare Form 4+

Jotform Health is a secure medical form builder that lets healthcare organizations collect patient information, file uploads, e-signatures, fee payments, and more. Build custom HIPAA-compliant medical forms in minutes, complete with a Business Associate Agreement (BAA) to keep patient medical data safe. Healthcare organizations, doctors, and specialists no longer need to use messy paper forms — with Jotform Health, you can seamlessly collect the information you need from any device, online or offline, and store it in a secure Jotform account.

** Create Forms Without Coding
Building a HIPAA-compliant form with Jotform just takes a couple of minutes, and zero technical skill. You can make your own form or use our professional healthcare form templates.

** Stay HIPAA Compliant
Our HIPAA-compliant forms encrypt submission data automatically, guaranteeing the privacy of your patients' health information. You'll also receive a signed Business Associate Agreement (BAA) that creates binding liability and keeps your business protected.

** Schedule Appointments
Arrange medical appointments, schedule voice or video calls, receive meeting requests, and more. Patients can easily book appointments by selecting a date and time on your form. With our Google Calendar integration, appointments booked through your form will automatically become events in your calendar.

** Obtain Informed Consent
Customize your medical form to describe your patients’ treatment, any possible risks, and their right to refuse treatment. Patients can sign your consent form with their legally binding electronic signature. You can even convert each submission into a downloadable, printable PDF!

** Accept Medical Bill Payments
Let patients pay appointment fees or medical bills directly through your forms. Connect your medical form to dozens of secure payment processors, including PayPal, Square, Stripe, and Authorize.Net. You won’t have to pay any additional transaction fees.

** Collect Patient Signatures and Files
Patients can easily sign your forms with legally-binding electronic signatures and attach important medical documents, images, and other files.

** Integrate with 100+ Apps
Connect your forms and surveys to HIPAA-compliant software like G Suite and Dropbox to sync submissions automatically and make patient data more organized and accessible for your team.

** Enable Mobile Responses
All forms are mobile-responsive and can be filled out on any smartphone, tablet or computer with ease. Patients can check in to their appointment, register as a new patient, or update their medical history directly on your office’s device.

** Streamline Your Workflow
Organize your patients’ data. You can export form data as PDFs and automatically email them to your patients — or seamlessly integrate with other HIPAA-compliant software such as Dropbox, G Suite, and more.

*** KEY FEATURES ***

** Automate Your Workflow
- Create and manage patient registration forms, consent forms, intake forms, self-assessment forms, screening forms, emergency forms, surveys, and more!
- Add conditional logic, calculations, and widgets
- Set up autoresponders to send confirmation emails and reminders
- Get notified of submissions instantly with push notifications
- Collect multiple submissions at once with kiosk mode
- Provide a touchless form-filling experience for your patients with QR codes

** Collaborate with your team
- Share forms via email, text, and other mobile apps (Facebook, Slack, LinkedIn, WhatsApp, etc.)
- Assign forms to patients or colleagues and view their responses

** Advanced Form Fields
- Appointment calendar
- GPS location capture
- QR code and barcode scanner
- Voice recorder
- Signature capture (24/7 mobile sign)
- File upload
- Take photo

** Keep Patient Data Safe
- 256-bit SSL encryption
- PCI DSS Level 1
- GDPR compliance
- HIPAA compliance

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