Adding field's label and other settings

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Once you do this, you will be prompted to label the field. You can use this text box to require the patient's name, medical record number, phone number, date of birth, and more. You can also enable the toggles to make the field required or configure other customizations.

Then, scroll down the customization panel and click “Save Changes” to store your settings.

Now, you can repeat this step as many times as you want to add all the required fields in the form.

Next, you may want to add a protected health information disclosure. You can add multiple “display options” to create a multiple choice field.

Adding multiple choices
In the customization panel that appears, you can change the label name, adjust the choices, and south africa telemarketing data make the field mandatory.

You can add more options by clicking on the “+ Add Option” button. Then, simply fill in the necessary details for your choice.

Don’t forget to scroll down and click “Save Changes” when you’re ready.

The next step is to add the “Signature” field to your HIPAA form. This field is important because it allows you to obtain patient consent and authorization. This way, you can ensure that your WordPress form is HIPAA compliant.

Simply drag and drop “Signature” to the right side of the builder and adjust the necessary information.

Here's an example:

Adding signature box
Done!

Our HIPAA form example only includes the basics, but you can certainly add more fields to meet your needs. Feel free to play around with the text fields and other options available.