Kit contents
HIPAA Wellness & PHI Consent Kit
- 01Branching intake by visit type (chiro, massage, PT, integrative)form
- 02Health-history block with current conditions, surgeries, medications, allergiesform
- 03Pain-mapping section with body diagram for chiro and PT visitsform
- 04Treatment-specific consent (manual adjustment, deep-tissue, dry needling, modality risks)form
- 05Photo and video release for treatment documentation (optional, opt-in)form
- 06Emergency contact and primary care provider captureform
- 07Patient confirmation with first-visit expectations and what to wear - no PHI in bodyemail
- 08Provider notification - 'new submission for [provider name], click to view'email
- 09Treatment consent confirmation with link to signed copy in patient portalemail
- 10Pre-visit reminder 24 hours before appointmentemail
- 11Re-consent prompt at one-year mark for returning patientsemail
- 12Conditional branching by visit type so chiro patients do not get PT-only questionsworkflow
- 13Auto-flagging of contraindications (anticoagulants for deep-tissue, recent surgery for adjustment)workflow
- 14Routing to the named provider plus front desk - no broadcast notificationsworkflow
- 15Photo release retention separate from clinical record for cleaner deletion pathsworkflow
- 16Audit-trail note on every consent and treatment releaseworkflow
- 17Jotform HIPAA plan with signed BAA - requiredintegration
- 18Practice management software handoff via CSV export or webhookintegration
- 19PHI-safe storage for photo and video releases (Jotform retention or BAA Drive folder)integration
- 20Calendar handoff to Google Calendar, Calendly, or Mindbody (Mindbody for booking only - PHI stays in Jotform)integration
- 21Optional SMS reminder via BAA-covered SMS providerintegration
- 22Body-diagram tool for pain mapping (visual input, not text-only)extra
- 23Bilingual intake (English + Spanish)extra
- 24Mobile-first design tested on phones for in-clinic check-inextra
- 25Re-consent automation to comply with annual consent refresh expectationsextra
