Healthcare · Automation Kit

Patient intake that moves: HIPAA-aware, insurance-ready, EHR-compatible

Updated May 5, 2026

Paper intake stacks up. PDF intake creates handoff errors. Generic online forms aren't HIPAA-friendly and don't fit how medical history actually branches. Your front desk ends up retyping fields into the EHR and still misses things.

Get this kit: $149 Book a 20-minute call

What you'll receive

4 Forms
4 Emails
4 Workflows
4 Integrations
2 Extras

Plus: Bilingual intake variant (English + Spanish) with mirrored conditional logic, Mobile-first design tested on iOS and Android. Photo upload for insurance cards optimized for phone cameras

Installed in your Jotform account.
You own everything. No monthly fees to me.

Kit contents

HIPAA Patient Intake Kit

0101: Multi-section intake form with conditional branching by visit type (new patient, follow-up, procedure-specific)form
0202: Medical history section: medications (name/dose/frequency), allergies with severity, surgical history, chronic conditionsform
0303: Insurance capture: front/back card photo upload, policy/group number, subscriber info, primary vs secondary insuranceform
0404: Consent form with legally-binding e-signature (treatment consent, privacy notice acknowledgment, financial responsibility)form
0501: Patient confirmation with pre-visit checklist (what to bring, arrival time, parking info): zero PHI in bodyemail
0602: Front-desk internal notification: 'new intake submission: click to view' with link to authenticated Jotform viewemail
0703: Insurance verification reminder if card image missing from submissionemail
0804: Pre-visit reminder 24 hours before appointment with check-in instructionsemail
0901: Visit-type branching: new patient sees full history; follow-up sees abbreviated form with updated-meds section onlyworkflow
1002: Allergy and condition flagging: known allergies auto-highlighted in front-desk notification; high-risk conditions flagged for provider reviewworkflow
1103: Insurance card routing: card images auto-forwarded to billing verification inboxworkflow
1204: Consent tracking: e-signed consent with timestamp stored; returning patients prompted only for updated consent if > 12 monthsworkflow
13Jotform HIPAA plan (Gold or Enterprise) with signed BAA: required for all PHI workflowsintegration
14EHR-ready structured export (CSV or JSON) for batch import into any EHRintegration
15Google Drive or Dropbox (encrypted folder under BAA for card images and signed consent PDFs)integration
16Stripe (co-pay or outstanding balance collection at check-in)integration
17Bilingual intake variant (English + Spanish) with mirrored conditional logicextra
18Mobile-first design tested on iOS and Android. Photo upload for insurance cards optimized for phone camerasextra

System diagram

The solution

How this kit actually works.

Patient intake on paper means double-entry, lost forms, and a HIPAA exposure on every fax. This kit handles intake, conditional branching by visit type, BAA-bound storage, and authenticated submission view. Insurance-card upload, e-signature, and EHR-ready export included.

What's included

Every piece, ready the day you buy it.

Forms

01: Multi-section intake form with conditional branching by visit type (new patient, follow-up, procedure-specific)
02: Medical history section: medications (name/dose/frequency), allergies with severity, surgical history, chronic conditions
03: Insurance capture: front/back card photo upload, policy/group number, subscriber info, primary vs secondary insurance
04: Consent form with legally-binding e-signature (treatment consent, privacy notice acknowledgment, financial responsibility)

Emails

01: Patient confirmation with pre-visit checklist (what to bring, arrival time, parking info): zero PHI in body
02: Front-desk internal notification: 'new intake submission: click to view' with link to authenticated Jotform view
03: Insurance verification reminder if card image missing from submission
04: Pre-visit reminder 24 hours before appointment with check-in instructions

Workflows

01: Visit-type branching: new patient sees full history; follow-up sees abbreviated form with updated-meds section only
02: Allergy and condition flagging: known allergies auto-highlighted in front-desk notification; high-risk conditions flagged for provider review
03: Insurance card routing: card images auto-forwarded to billing verification inbox
04: Consent tracking: e-signed consent with timestamp stored; returning patients prompted only for updated consent if > 12 months

Integrations

Jotform HIPAA plan (Gold or Enterprise) with signed BAA: required for all PHI workflows
EHR-ready structured export (CSV or JSON) for batch import into any EHR
Google Drive or Dropbox (encrypted folder under BAA for card images and signed consent PDFs)
Stripe (co-pay or outstanding balance collection at check-in)

Extras

Bilingual intake variant (English + Spanish) with mirrored conditional logic
Mobile-first design tested on iOS and Android. Photo upload for insurance cards optimized for phone cameras

Pricing

Pick the fit. Upgrade later if you need to.

Base Kit

Ready to run, self-setup

$149

All forms, emails, and workflow configs
HIPAA setup documentation
30-minute video walkthrough
14-day email support

Buy base kit: $149

Pro Setup

Kit + setup call + customization

$279

Everything in Base
60-minute setup call
HIPAA compliance checklist review
Insurance routing and EHR export configured
30-day email support

Buy pro setup: $279

Done-For-You

Full implementation by me

$1500

Everything in Pro
Full implementation in your HIPAA Jotform account
Front-desk staff training session
Custom EHR integration setup
90-day priority support

Book a call

Frequently asked

The questions I get before someone buys.

Is this actually HIPAA-compliant?
This workflow meets HIPAA requirements when you deploy it on a Jotform HIPAA plan (Gold or Enterprise with a signed BAA). The kit includes the checklist, form-level settings, and storage configuration required. You also need your own signed BAA with Jotform. The Pro and Done-For-You tiers walk you through it.
Does this work with my EHR?
The kit exports in structured CSV or JSON that most EHRs accept. For direct API integration with Epic, Cerner, Athena, or similar: that's scoped into the Done-For-You tier.
What does the BAA cover for this kit specifically?
The Jotform BAA covers everything that lives inside Jotform once the kit is installed: intake submissions, file uploads, e-signature records, PDF generation, and email infrastructure. It does not extend to downstream tools you connect (your EHR, scheduling app, Zapier, payment processor). Each of those needs its own BAA. The Done-For-You tier audits the full chain and produces a decision log of every BAA on file.
Can I integrate this with my EHR directly?
Yes for EHRs with proper APIs (DrChrono, Athena, some Epic deployments). We wire a real-time webhook + API call. For SimplePractice, TherapyNotes, Kareo, and others without deep inbound APIs, the integration is a structured CSV or JSON batch import. The Done-For-You tier scopes this on the kickoff call.
What if a patient doesn't finish the form?
Jotform auto-saves drafts. The workflow sends a resume link if the patient abandons mid-form, and front desk sees partial submissions so you can follow up.
Do I need a Jotform HIPAA plan?
Yes. HIPAA compliance requires the Gold HIPAA plan or Enterprise. You can get a discount through our partner link, but do not deploy PHI workflows on standard plans.

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Not sure if this is the right kit?

Free 20-minute call. Tell me what you're trying to do - I'll tell you if a kit fits, or if you need something custom, or if you shouldn't pay me at all.

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Every piece, ready the day you buy it.

Forms

01: Multi-section intake form with conditional branching by visit type (new patient, follow-up, procedure-specific)
02: Medical history section: medications (name/dose/frequency), allergies with severity, surgical history, chronic conditions
03: Insurance capture: front/back card photo upload, policy/group number, subscriber info, primary vs secondary insurance
04: Consent form with legally-binding e-signature (treatment consent, privacy notice acknowledgment, financial responsibility)

Emails

01: Patient confirmation with pre-visit checklist (what to bring, arrival time, parking info): zero PHI in body
02: Front-desk internal notification: 'new intake submission: click to view' with link to authenticated Jotform view
03: Insurance verification reminder if card image missing from submission
04: Pre-visit reminder 24 hours before appointment with check-in instructions

Workflows

01: Visit-type branching: new patient sees full history; follow-up sees abbreviated form with updated-meds section only
02: Allergy and condition flagging: known allergies auto-highlighted in front-desk notification; high-risk conditions flagged for provider review
03: Insurance card routing: card images auto-forwarded to billing verification inbox
04: Consent tracking: e-signed consent with timestamp stored; returning patients prompted only for updated consent if > 12 months

Integrations

Jotform HIPAA plan (Gold or Enterprise) with signed BAA: required for all PHI workflows
EHR-ready structured export (CSV or JSON) for batch import into any EHR
Google Drive or Dropbox (encrypted folder under BAA for card images and signed consent PDFs)
Stripe (co-pay or outstanding balance collection at check-in)

Extras

Bilingual intake variant (English + Spanish) with mirrored conditional logic
Mobile-first design tested on iOS and Android. Photo upload for insurance cards optimized for phone cameras

Pick the fit. Upgrade later if you need to.

Base Kit

Ready to run, self-setup

$149

All forms, emails, and workflow configs
HIPAA setup documentation
30-minute video walkthrough
14-day email support

Buy base kit: $149

Pro Setup

Kit + setup call + customization

$279

Everything in Base
60-minute setup call
HIPAA compliance checklist review
Insurance routing and EHR export configured
30-day email support

Buy pro setup: $279

Done-For-You

Full implementation by me

$1500

Everything in Pro
Full implementation in your HIPAA Jotform account
Front-desk staff training session
Custom EHR integration setup
90-day priority support

Book a call

The questions I get before someone buys.

Is this actually HIPAA-compliant?

This workflow meets HIPAA requirements when you deploy it on a Jotform HIPAA plan (Gold or Enterprise with a signed BAA). The kit includes the checklist, form-level settings, and storage configuration required. You also need your own signed BAA with Jotform. The Pro and Done-For-You tiers walk you through it.

Does this work with my EHR?

The kit exports in structured CSV or JSON that most EHRs accept. For direct API integration with Epic, Cerner, Athena, or similar: that's scoped into the Done-For-You tier.

What does the BAA cover for this kit specifically?

The Jotform BAA covers everything that lives inside Jotform once the kit is installed: intake submissions, file uploads, e-signature records, PDF generation, and email infrastructure. It does not extend to downstream tools you connect (your EHR, scheduling app, Zapier, payment processor). Each of those needs its own BAA. The Done-For-You tier audits the full chain and produces a decision log of every BAA on file.

Can I integrate this with my EHR directly?

Yes for EHRs with proper APIs (DrChrono, Athena, some Epic deployments). We wire a real-time webhook + API call. For SimplePractice, TherapyNotes, Kareo, and others without deep inbound APIs, the integration is a structured CSV or JSON batch import. The Done-For-You tier scopes this on the kickoff call.

What if a patient doesn't finish the form?

Jotform auto-saves drafts. The workflow sends a resume link if the patient abandons mid-form, and front desk sees partial submissions so you can follow up.

Do I need a Jotform HIPAA plan?

Yes. HIPAA compliance requires the Gold HIPAA plan or Enterprise. You can get a discount through our partner link, but do not deploy PHI workflows on standard plans.