Pediatric Symptom Checklist Form Template

The Pediatric Symptom Checklist is a standardized screening tool to assess for social, emotional, and behavioral issues in children. Providers can use this information prior to the appointment to best direct the conversation and assessment of the child.
Pediatric-Symptom-Checklist

Pediatric Symptom Checklist Form Template

Give parents and guardians the freedom to complete the Pediatric Symptom Checklist with any device, anywhere. Enable them to answer sensitive questions in privacy at a comfortable and unhurried time.

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What is the Pediatric Symptom Checklist?

This form enables parents and guardians to express the changes they are seeing in their child’s behavior, emotions, or learning. Because parents/guardians know their children best, this is vital information for the provider to form a plan of care for the child.  

A child’s daily functioning is an expression of their strengths and stressors. A child’s functioning is the common pathway for the influence of genetics, their psychological development, social determinants of health, coping abilities, and resilience.

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

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Sync HIPAA Compliant Form Submissions to Google Drive

Sync Submissions to Google Drive

When you receive a patient form submission, automatically send the submission directly to your Google Drive folder.

Resend HIPAA Compliant Forms

Resend HIPAA Compliant Forms

Resend completed patient intake forms. Patients will simply update what has changed, and leave the rest of the form completed.

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Dedicated Servers

Host your HIPAA compliant online forms and PHI on a dedicated server with a FormDr White Label Enterprise account. Keep your patient’s data secure while collecting form submissions with any device, anywhere, at any time.

Print HIPAA Compliant Submissions

Print HIPAA Compliant Form Submissions

Print your patients’ submissions after the forms have been completed online. Adjust the formatting and text size to match your original paper forms.

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
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