Forms and Appendices

Hospitals that are members of the California Hospital Association may use these model forms, appendices, signs and handouts as templates in developing their own forms, signs and handouts.

CHA forms are updated periodically. The current version of CHA forms are downloadable from this page, and may or may not match the forms found in CHA’s printed manuals. The date on which each form was last updated appears in the lower right corner of each form.

Hospitals that are members of the California Hospital Association may use these model forms, appendices, signs and handouts as templates in developing their own forms, signs and handouts.

This content is restricted to members.

Showing 1 - 25 of 209 results

Form Number Form Name Associated Manual(s)
Model Hospital Compliance Plan Hospital Compliance Manual
Model Medical Bylaws Templates Model Medical Staff Bylaws & Rules
Pertinent DHCS Plan Letters 2024 Consent Manual
1-1 Consent to Surgery or Special Procedure 2024 Consent Manual
1-2 Informed Consent to Surgery or Special Procedure 2024 Consent Manual
1-A Patient Rights 2024 Consent Manual, Hospital Compliance Manual
2-1 Self-Sufficient Minor Information 2024 Consent Manual
2-2 Caregiver’s Authorization Affidavit 2024 Consent Manual
2-3 Authorization for Third Party to Consent for Treatment of Minor Lacking Capacity to Consent 2024 Consent Manual
2-A Decision Makers for Medical Treatment of Adults
2-B Consent Requirements for Medical Treatment of Minors
2-C Selection of Health Care Surrogates With the Assistance of Health Care Professionals – Sample Policy 2024 Consent Manual
2-D Health Care Decisions for Unrepresented Patients 2024 Consent Manual
2-E Considerations for Revising the Hospital’s Policy and Procedure Regarding Decision Making for Unrepresented Patients 2024 Consent Manual
3-1 Advance Health Care Directive 2024 Consent Manual
4-1 Transfusion Information Form 2024 Consent Manual
4-3 Authorization for and Consent to Hysterectomy 2024 Consent Manual
4-4 Employee or Medical Staff Member Statement 2024 Consent Manual
4-5 Release from Responsibility for Treatment of Miscarriage or Partial Abortion 2024 Consent Manual
4-6 Consent to Reuse of Hemodialysis Filters 2024 Consent Manual
4-7 Consent to Receive Antipsychotic Medications 2024 Consent Manual
4-8 Consent to Donation of Sperm, Ova or Embryos 2024 Consent Manual
4-9 Consent to Implantation of Sperm, Ova or Embryo 2024 Consent Manual
4-11 Directive Regarding Embryo Disposition 2024 Consent Manual
4-B Be Informed (Breast Cancer) 2024 Consent Manual, Hospital Compliance Manual