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Article | April 2015
Commonly Used Patient Forms in Spanish
Consent, Refusal, Instruction and Treatment forms for Spanish-speaking patients.
When your patient's primary language is Spanish, it impedes your ability to get accurate information with English forms. Use these Spanish forms from Cigna HealthcareSM for better communication, and better care.
Download the packet [PDF] and get access to all these forms and instructions:
- Consent to Immunization - Adult
- GI Consent to Operation or Other Medical Services
- Consent to Photograph
- Consent for Depo-Provera
- Important Information about Influenza and Influenza Vaccine
- Consent to Medical Treatment of a Minor
- Outpatient Surgery Consent to Operation or Other Medical Services
- Informed Consent for Psychotropic Medication Treatment
Refusal of Treatment or Services Forms
- Refusal of Medical Services Against Medical Advice
- Refusal to Vaccinate
Treatment Instructions and Other Clinical Forms
- Blood Pressure Pocket Card
- Endoscopy Outpatient Discharge Instructions
- Home Instructions - Medical
- Pediatric Sports Physical History
- Pre-Stimulant Cardiac Screening Checklist
- Home Instructions - Trauma
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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna Healthcare.
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