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.

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Showing 1 - 25 of 209 results

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