Newsletters and Reports
Order Form for Office Forms and Patient-Education Brochures
Risk Management Forms and Sample Letters
Risk Management Manual
Risk Management Patient Materials
Risk Management Specialty Materials
More Useful Risk Management Tools
Newsletters and Reports
Annual Report: our most current annual report, outlining our financial accomplishments of the year
Physicians Report: our most current quarterly publication updating physicians and staff with the latest company news
Risk Management Tips: brief risk management guidance we publish several times each year for physicians and staff
Risk Management Updates: a list of articles we publish several times each year to educate physicians and staff on current risk management topics
Order Form for Office Forms and Patient-Education Brochures
Physicians Insurance offers a variety of office forms and patient-education brochures to insureds at no charge. To order, please use our
online order form. If you would rather receive samples of our materials, contact us at
orders@phyins.com or call us at (206) 343-7300 or 1-800-962-1399 between 8 a.m. and 5 p.m., Monday through Friday.
Risk Management Forms and Sample Letters
The prenatal health questionnaire and prenatal record form are examples of our high-quality forms for physicians. All health care professionals are free to download these two forms.
Prenatal Health Questionnaire (
PDF 204 KB)
Prenatal Record Form (
PDF 276 KB)
All of the forms, sample letters, manuals, patient materials, and specialty materials below are available only to members:
Accounting Log for Protected Health Information Disclosures (
Word 48 KB) (
PDF 100 KB)
Advance Consent to Treat Minors (
Word 16 KB) (
PDF 76 KB)
Agreement for Use of Medication in Pain Management (
Word 20 KB) (
PDF 76 KB)
Authorization for Release of Information Regarding Provider Professional Qualifications (
Word 8 KB) (
PDF 80 KB)
Authorization to Use or Disclose Protected Health Information (
Word 24 KB) (
PDF 152 KB)
Closing Your Practice Letter (
Word 12 KB) (
PDF 76 KB)
Complaint/Grievance Resolution Letter (
Word 8 KB) (
PDF 76 KB)
Controlled Substance Prescription Receipt (
Word 12 KB) (
PDF 76 KB)
Denying Request to Access Protected Health Information (
Word 20 KB) (
PDF 80 KB)
Denying Request to Correct or Amend Protected Health Information (
Word 24 KB) (
PDF 84 KB)
Diagnostic Test Tracking Log (
Word 44 KB) (
PDF 100 KB)
Employee Confidentiality Statement (
Word 16 KB) (
PDF 80 KB)
Fax Disclaimer Language (
Word 8 KB) (
PDF 76 KB)
Informed Consent—Patient Education Version (
Word 36 KB) (
PDF 36 KB)
Informed Consent—Standard Version (
Word 24 KB) (
PDF 68 KB)
Kinship Caregivers Informed Consent Declaration for Minors (
Word 16 KB) (
PDF 96 KB)
Medication Flowsheet (
Word 48 KB) (
PDF 4 KB)
Nonemployee Confidentiality Statement (
Word 20 KB) (
PDF 80 KB)
Notice of Privacy Practices (
Word 76 KB) (
PDF 84 KB)
Notice of Privacy Practices Acknowledgment (
Word 8 KB) (
PDF 104 KB)
Patient Care Agreement Form (
Word 16 KB) (
PDF 76 KB)
Patient SAFE assessment tools coming soon! Call our risk management experts for more information, at 1-800-962-1399.
Patient Telephone Call Record (message slip) (
PDF 12 KB)
Prenatal Health Questionnaire (
PDF 204 KB)
Prenatal Record Form (
PDF 276 KB)
Prescription Refill Policy (
Word 16 KB) (
PDF 408 KB)
Professional Witness Fee Agreement (
Word 12 KB) (
PDF 76 KB)
Refusal of Care Letter (
Word 12 KB) (
PDF 76 KB)
Refusal of Recommended Treatment (
Word 16 KB) (
PDF 76 KB)
Refusal to Authorize Payment Letter (
Word 12 KB) (
PDF 76 KB)
Request to Correct or Amend Protected Health Information (
Word 16 KB) (
PDF 84 KB)
Response to Defective Subpoena or Incomplete Request to Disclose Protected Health Information (
Word 20 KB) (
PDF 76 KB)
Revocation of Authorization to Use or Disclose Protected Health Information (
Word 16 KB) (
PDF 76 KB)
Sample Drugs Form (
Word 12 KB) (
PDF 400 KB)
Signature Log (
Word 12 KB) (
PDF 76 KB)
Termination of Care Letter (
Word 12 KB) (
PDF 76 KB)
Upset Patient Letter (
Word 12 KB) (
PDF 76 KB)
Risk Management Manual
Risk Management Reference Guide (
PDF 1537 KB): a manual designed for physicians who want to keep their practices safe from malpractice claims (publication date: November 2007)
To access individual sections and sample forms in the manual, see the
chapter list on our members-only page.
Risk Management Patient Materials
Answers About Anesthesia
(PDF 576 KB)
Having a Healthy Baby
(PDF 824 KB)
How Are We Doing? (
PDF 796 KB)
Labor and Delivery: Choices & Decisions (
PDF 608 KB)
Risk Management Specialty Materials
Anesthesia:
Adult Awake Intubation (
PDF 1.9 MB)
Airway Approach Algorithm (
PDF 60 KB)
Decision Making in Airway Management (
PDF 52 KB)
Emergency Medicine:
Adult Awake Intubation (
PDF 1.9 MB)
Airway Approach Algorithm (
PDF 60 KB)
Chest Pain Evaluation Guidelines (
PDF 60 KB)
Decision Making in Airway Management (
PDF 52 KB)
OB/GYN:
CDC Culture-Based Strategy (
PDF 84 KB)
Forceps/Vacuum Dictation Guide/Operative Note (
PDF 64 KB)
Having a Healthy Baby (
PDF 824 KB)
HELPER for Shoulder Dystocia (
PDF 136 KB)
Labor and Delivery: Choices & Decisions (
PDF 608 KB)
Neonatal Resuscitation Program Reference Chart (
PDF 2.1 MB)
Prenatal Health Questionnaire (
PDF 204 KB)
Prenatal Record Form (
PDF 276 KB)
Proposed Statement for Informed Consent (
PDF 128 KB)
Sample Infant Code Record (
PDF 276 KB)
Serum Marker Screen Second-Trimester Screening (
PDF 32 KB)
Shoulder Dystocia Dictation Guide Chart Form Sample (
PDF 72 KB)
More Useful Risk Management Tools
Chest Pain Evaluation Guidelines (
PDF 60 KB)
Coordinated Quality Improvement Plan Template (
Word 140 KB)
Cross-Cultural Communication as a Risk Management Issue (
PDF 184 KB)
HIPAA Privacy Forms in German, Russian, Spanish, Tagalog, and Vietnamese:
www.awphd.org/Publications/resources_translatedForms.aspx
Infectious Disease Pearls (
PDF 28 KB)
Medical Records Self-Assessment Guide (
Word 44 KB) (
PDF 84 KB)
Medication Error Self-Assessment Survey (
Word 64 KB) (
PDF 92 KB)
Patient Telephone Call Record (message slip) (
PDF 12 KB)
Physicians Insurance Guide to Adopting Electronic Medical Records (
PDF 148 KB)
Risk Management Essentials: A Self-Study Course for Medical Office Staff (
PDF 23 KB)
Summary of Washington Death with Dignity Act
(Word 111 KB)
