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 51 - 75 of 209 results

Form Number Form Name Associated Manual(s)
4-9 Consent to Implantation of Sperm, Ova or Embryo Consent Manual
24-3 Consent to Photograph Consent Manual, California Health Information Privacy Manual
24-4 Consent to Photograph and Authorization for Use and Disclosure Consent Manual
4-7 Consent to Receive Antipsychotic Medications Consent Manual
4-6 Consent to Reuse of Hemodialysis Filters Consent Manual
1-1 Consent to Surgery or Special Procedure Consent Manual
23-1 Consent to the HIV Test Consent Manual
9-3 Consent to Transfer for Medical Treatment Consent Manual
2-E Considerations for Revising the Hospital’s Policy and Procedure Regarding Decision Making for Unrepresented Patients Consent Manual
10-7 Consultation Regarding Length of Stay After Childbirth Consent Manual
Appendix E CoP for Emergency Services: Hospital Interpretive Guidelines EMTALA Manual
2-A Decision Makers for Medical Treatment of Adults
WVP Appendix D Definition of “Dangerous Weapon” for Law Enforcement Reporting Requirement Healthcare Workplace Violence Prevention
HS 11 Definitions of Hospitals Under California Law California Hospital Survey Manual
11-3 Delivery of Personal Property of Deceased Patient Consent Manual
PR 16-8 Deposition Subpoena for Personal Appearance and Production of Documents and Things California Health Information Privacy Manual
PR 16-9 Deposition Subpoena for Production of Business Records California Health Information Privacy Manual
12-12 Detention of Patient With Psychiatric Emergency in a Nondesignated Health Facility (Health and Safety Code Section 1799.111) Consent Manual
Appendix 9-D DHCS Chart: Medi-Cal Mental Health Services Consent Manual
4-11 Directive Regarding Embryo Disposition Consent Manual
PR 3-A Disclosures That Must Be Accounted For California Health Information Privacy Manual
DP 1-C Documentation of Homeless Patient Discharge Planning Training The Cal/OSHA Safe Patient Handling Regulation, Discharge Planning for Homeless Patients
WVP 1-B Documentation of Investigation of Workplace Violence Incident Healthcare Workplace Violence Prevention
WVP 1-C Documentation of Workplace Violence Prevention Training Healthcare Workplace Violence Prevention
19-2 Employee Acknowledgment of Child Abuse and Neglect Reporting Obligations Consent Manual