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 51 - 75 of 209 results

Form Number Form Name Associated Manual(s)
9-11 Consent for Participation in Patient Outing 2024 Consent Manual
10-1 Authorization for Release of a Minor 2024 Consent Manual
10-2 Acknowledgment of Release of a Minor 2024 Consent Manual
10-3 Release of a Child Under 8 Years of Age 2024 Consent Manual
10-4 Newborn Family Medical History Questionnaire 2024 Consent Manual
10-5 Refusal to Permit Rho(D)-Immune Globulin Administration 2024 Consent Manual
10-6 Refusal to Permit Administration of an Approved Prophylactic Agent to the Eyes of Newborn 2024 Consent Manual
10-7 Consultation Regarding Length of Stay After Childbirth 2024 Consent Manual
10-A Baby Stalking Sign 2024 Consent Manual, Hospital Compliance Manual 2025
10-B Safe Surrender Site Sign Hospital Compliance Manual 2025
10-C Obstetrical Care Notice Hospital Compliance Manual 2025
11-1 Authorization for Autopsy 2024 Consent Manual
11-2 Authorization for Anatomical Gift 2024 Consent Manual
11-3 Delivery of Personal Property of Deceased Patient 2024 Consent Manual
12-1 Request for Voluntary Admission and Authorization for Treatment 2024 Consent Manual
12-2 Statement of Professional Person Responsible for Minor’s Admission 2024 Consent Manual
12-3 Notice to Minors 2024 Consent Manual
12-4 Certificate of Admitting Physician 2024 Consent Manual
12-5 Application of Involuntary Admission – Inebriates 2024 Consent Manual
12-6 Notice of Certification for Intensive Treatment 2024 Consent Manual
12-7 Advisement of Rights – Involuntary Patient 2024 Consent Manual
12-8 Leave of Absence from Psychiatric Service 2024 Consent Manual
12-9 Request for Release from Involuntary Treatment 2024 Consent Manual
12-10 Notice of Certification to Second Involuntary 14-Day Period for Intensive Treatment – Suicidal Patient 2024 Consent Manual
12-11 Petition for Postcertification Treatment of Imminently Dangerous Person 2024 Consent Manual