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 26 - 50 of 209 results

Form Number Form Name Associated Manual(s)
4-C Be Informed (Prostate Cancer) Consent Manual
5-1 Refusal to Permit Medical Treatment Consent Manual
5-2 Refusal of Blood Products Consent Manual
5-3 Leaving Hospital Against Medical Advice Consent Manual
5-4 Request Regarding Resuscitative Measures Consent Manual
5-B Physician Orders for Life-Sustaining Treatment (POLST) Consent Manual
6-1 Blood Test Request by Peace Officer Consent Manual, California Health Information Privacy Manual
6-2 Medical Evaluation Request by Peace Officer Consent Manual, California Health Information Privacy Manual
6-3 Warrantless Medical Search Request by Peace Officer (When Subject Refuses to Consent) Consent Manual
7-1 Experimental Subject’s Bill of Rights Consent Manual
8-1 Conditions of Admission Consent Manual
8-2 Notice of Lien Consent Manual
8-3 Assignment of Proceeds of Claim Consent Manual
8-4 Mutual Arbitration Agreement Consent Manual
8-5 Sample Arbitration Clause Consent Manual
9-1 Patient Refusal of Transfer Consent Manual
9-2 Transfer Summary (Transfer From Acute Hospital to SNF) Consent Manual
9-3 Consent to Transfer for Medical Treatment Consent Manual
9-4 Physician Certification Consent Manual
9-5 Physician Authorization for Transfer Consent Manual
9-6 Patient Refusal of Further Medical Treatment Consent Manual
9-7 Patient Transfer Acknowledgment Consent Manual
9-8 Patient Request for Transfer or Discharge Consent Manual
9-9 Notice for Emergency Room Mental Health Law Manual, Consent Manual, Hospital Compliance Manual
9-10 Temporary Absence Release Consent Manual