Health Screening Form

A printable health screening form template that is functional, accessible, and easy to use. With this resource, you can maximize productivity and elevate clinical outcomes.

By Matt Olivares on Jun 20, 2024.

Fact Checked by Ericka Pingol.

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Health Screening Form PDF Example
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What is a Health Screening Form?

Health screening forms differ based on the scenarios in which they are used. In general, they aim to collect information about specific areas of an individual’s health and assess their fitness for a certain role in an effective and economic way. For example, these forms can be used during the recruitment of healthcare professionals to check for infectious blood bourne diseases such as HAV, HBV, HCV, etc. During the COVID-19 pandemic, health screening forms were an important filter at clinics and hospitals to quickly identify a population with potential symptoms and limit the spread of the virus. Health screening forms take around 15 minutes to complete, and ensure that all relevant health information is listed in one place.

Based on different scenarios and requirements, health screening forms can vary significantly. To satisfy the need of most scenarios, we have created a  that would cover some of the most prevalent infectious diseases and notable non-infectious diseases to suit most cases of use.

What is the importance of health screening forms?

Health screening forms are vital for early detection of healthcare issues and concerns. Health practitioners can quickly scan your health form, and trace symptoms to causes through a more clarified format. Discovering a problem before it intensifies allows for more effective treatment plans and outcomes. Not only this, but doctors can make more informed decisions regarding your health. In turn, you can better organize and manage health data from one place for more accurate diagnoses and assessments.

Printable Health Screening Form

Download these templates for health screening forms to improve your paperless intake process and HIPAA compliance.

How to Use This Template for Health Screening Form

The health screening form template is composed of 3 main sections: the patient section for the person being screened, the physician section for the examining healthcare professional, and the office use section for the third party that is distributing the form. The following is a detailed breakdown of how to approach these sections.

Step One: Download the Template

Download the template using the link on this page. Then, you can either choose to fill it out straight away on your computer or print it out. Adobe acrobat works best with our template, and the free version is sufficient. A health screening form example is also available to download which shows you what the form is like when it is filled.

Step Two: Select Relevant Fields

Within the ‘Office Use’ section, tick required for all the relevant fields that you want. This will help you and the people being screened to save a lot of time. Leave the irrelevant categories out to avoid wasting time.

Step Three: Send It Out

After you have done your part, forward it to the people being screened or their physician depending on what stage of screening they are at. Don’t forget to remind them that only the ‘required section’ needs to be filled.

Step Four: Store It Safely

All the information that ends up on this form is strictly confidential. The people being screened only consented for you to have it used for screening purposes only. Carefully look after these forms and make sure information is stored safely.

Health Screening Form Example (Sample)

It can be confusing to use a health screening form for the first time. Not sure about what to put in each section, or what to select? Don’t worry, we have made a health screening form sample to give you an idea of what it looks like in a healthcare setting.

Download this Health Screening Form example here: 

Health Screening Form Example

Who Can Use This Printable Health Screening Form (PDF)?

Health screening forms can be practically used by anyone, and are not just limited to healthcare providers. It can be used by enterprises for their employees’ health monitoring. During a pandemic, it can be a quick preliminary selection of who is fit to work and who needs to be tested for diseases. The health screening form is one of the most used forms in a healthcare setting. It is not restricted to any specific specialty or section of the healthcare system. Even for recruiting healthcare professionals, it is still necessary to use health screening forms to ensure that they do not carry diseases that will put patients at risk.

Clinicians who may use the form include general practitioners, nurses and nurse assistants, specialists, and more.

Why is This Form Useful for Clinicians?

Within healthcare services, a health screening form is an easy and straightforward method of figuring out any conditions of the patient that requires extra attention, like immunosuppressed conditions, heart conditions that put them at extra risk during surgeries, etc. It helps clinicians quickly identify patients that are not fit for procedures and treatment, reducing the risk of major medical malpractice. Our health screening form also divides common diseases that require screening into 3 sections, so the clinicians can select which of those need to be filled out to save time and effort for both the clinicians and their patients.

Health screening form review

Benefits of Health Screening Forms (PDF)

Easy Sharing

The health screening form pdf template can be easily printed or shared digitally in its own PDF format. Our PDF format is designed so that only a few sections are editable, so you do not have to worry about the format getting messy during the handover process.

Reduce Malpractice

With the help of health screening forms, healthcare professionals can easily identify conditions that require extra attention, avoiding medical malpractice that may severely impact the patient.

Effective Communication

With a PDF template that is elegantly designed, it is easy to pass on information about your patients to other healthcare professionals. Different categories of symptoms and diseases are also compartmented, so you can select only the relevant sections for your patients to fill out

Maximize Productivity

Making your own health screening form is time-consuming, and finding a decent one online is even harder. We have created an easy-to-use PDF template that you can fill straightaway without any hustle or extra steps. It will certainly save you and whoever else that needs to fill up the form a decent amount of time.

Legal Protection

Just in case something goes wrong, showing the health screening form of your patient will indicate your attempt to try and acquire the full circumstance of the patient’s health condition, giving you an extra layer of protection from a possible lawsuit.

Why Use Carepatron For Health Screening Form?

Carepatron is an online platform that is HIPAA compliant. This means two things. First, you can edit the health screening form practically anywhere in the world without having to ask your colleague to take a photo and send it to your email. As soon as you make the edit, the change also happens immediately, so you will never have to worry about delays in the information updates. The autosave feature will also save you from redoing your paperwork after an accidental power cutoff. 

Second, you do not need to worry about patient privacy anymore. All of your patient notes are stored safely within AWS servers that are controlled at the perimeter and building entry is monitored and protected 24/7. All the information is also protected using bank-level encryption with layers of AES-265 encryption, protecting your patient’s privacy at our best capacity.

Health screening form software review
What form is used to allow the release of medical records?
What form is used to allow the release of medical records?

Commonly asked questions

What form is used to allow the release of medical records?

To release patients’ medical records, a release of information form is required which is completely different from our health screening form. The release of information is to give access of current medical information to a third party, whereas the health screening form is merely collecting relevant information that is presented on the form. A health screening form cannot be used to authorize anyone to access a patient’s medical record. Luckily, if you need a release of information form template, you can find it in our template library.

What do you write in a health screening?

In a health screening form, the healthcare providers or third parties would usually specify the range of medical conditions that are highly relevant to the specific circumstances. All you have to do is to fill out your credentials and tick boxes, and of course, feel free to comment on any medical conditions that you may think are worth mentioning, but are not listed in the form. If you are a physician, you would need to examine the patient and fill out the results in their respective fields.

Why are health screening forms important?

Health screening forms serve an important function in both secondary prevention and risk reduction. It tells healthcare professionals about certain vital medical conditions, so they can avoid certain treatments or operations that may harm you. Screening basic vital signs also helps identify life-threatening medical conditions before they become lethal.

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