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How to Create the Proper Format of a Patient Information Sheet

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Health care providers use different patient information forms. You can create a sheet using predetermined (name, address, age, social security number) as well as blank slots (describe symptoms, add anything that you want doctor to know). While you can provide new and returning clients with hard copy sheets, consider creating a PDF or secure intranet version so that patients can complete their sheets before they arrive.

Evaluate existing patient information sheets. Ask different people including physicians, dentists, nurses, receptionists, patient advocates, and case managers for their opinion about the current sheet. You might discover that key questions are missing or patients are overwhelmed with many pages.

Discuss essential patient information (name, gender, date of birth). For instance, you might require patients to disclose their mailing, residential, and email address. Other data might include emergency contacts, allergies, symptoms and medical history.

Evaluate patient information software. Although you can create a sheet using retail software (e.g., Microsoft Excel), consulting firms (e.g., IBM, Symantec) can custom develop a web-based system.

Establish a secure record-keeping system. If you use hard copy information sheets, you might create a patient file or scan the sheets into an electronic medical record. Make sure to incorporate a convenient way to update information sheets, such as when patients change insurance companies or addresses.

Test the information sheet and make revisions as needed. Before making a permanent change, you could ask patients for a few days to use the new sheet. If your practice deals with non-English speaking patients, develop information sheets in other languages, such as Arabic, Spanish or Mandarin.


While you can use a basic template, tailor the information sheet and consent form to your practice (orthodontia, podiatry, pediatrics). For instance, disclose all relevant information if the patient is participating in a clinic trial.


Carefully review federal and state legislation like the Health Insurance Portability and Accountability Act (HIPAA), which discusses patient confidentiality and privacy rights.


Maggie Gebremichael has been a freelance writer since 2002. She speaks Spanish fluently and resides in Texas. When she is not writing articles for, Gebremichael loves to travel internationally and learn about different cultures. She obtained an undergraduate degree with a focus on anthropology and business from the University of Texas and enjoys writing about her various interests.

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