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 101 - 125 of 209 results

Form Number Form Name Associated Manual(s)
Appendix F Knox-Keene Act Provisions EMTALA Manual
12-8 Leave of Absence from Psychiatric Service Consent Manual
5-3 Leaving Hospital Against Medical Advice Consent Manual
HC 10-B List of Miscellaneous Licenses Mental Health Law Manual, Hospital Compliance Manual
HS 6 Maximum Time Frames Related to the Federal On-Site Investigation of Complaints/Incidents California Hospital Survey Manual
6-2 Medical Evaluation Request by Peace Officer Consent Manual, California Health Information Privacy Manual
Appendix 9-A Medical Necessity for MHP Coverage Consent Manual
Appendix G Medicare Advantage Regulations EMTALA Manual
DP Appendix B Medicare Conditions of Participation for Discharge Planning The Cal/OSHA Safe Patient Handling Regulation, Discharge Planning for Homeless Patients
Model Hospital Compliance Plan Mental Health Law Manual, Hospital Compliance Manual
Appendix O Model Hospital Policy on Compliance with EMTALA EMTALA Manual
Model Medical Bylaws Templates Model Medical Staff Bylaws & Rules
15-2 Model Notice of Privacy Practices Consent Manual, California Health Information Privacy Manual
PR 15-2 Model Notice of Privacy Practices California Health Information Privacy Manual
15-3 Model Notice of Privacy Practices (For Mental Health Information Subject to the Lanterman-Petris-Short Act) Consent Manual, California Health Information Privacy Manual
PR 15-3 Model Notice of Privacy Practices: for Mental Health Information Subject to the Lanterman-Petris-Short Act California Health Information Privacy Manual
8-4 Mutual Arbitration Agreement Consent Manual
10-4 Newborn Family Medical History Questionnaire Consent Manual
9-9 Notice for Emergency Room Mental Health Law Manual, Consent Manual, Hospital Compliance Manual
12-6 Notice of Certification for Intensive Treatment Consent Manual
12-10 Notice of Certification to Second Involuntary 14-Day Period for Intensive Treatment – Suicidal Patient Consent Manual
HC 12-C Notice of Community Service Obligation (CHFCLI) Mental Health Law Manual, Hospital Compliance Manual
HC 12-D Notice of Community Service Obligation (CHFFA) Mental Health Law Manual, Hospital Compliance Manual
HC 12-E Notice of Hill-Burton Obligation Mental Health Law Manual, Hospital Compliance Manual
8-2 Notice of Lien Consent Manual