Pre-formatted Forms

Quick, helpful, handy risk management tools

Message Pads

Large medical liability judgements and awards continue to be paid in cases where defendant physicians fail to produce documentation of telephone advice and communications with patients. This is particularly common when:

  • the office is closed and a physician is on-call for his/her practice
  • one physician is covering several group practices
  • a curbside consultation occurs between physicians/health care providers.

To assist you with information management, the Risk Management Committee developed two styles of telephone message pads that facilitate documentation and recording of patient information, thereby promoting continuity of patient care and protection for you.

Single sheet pads:

The design of this form allows for easy attachment to an encounter sheet in your patient's medical record. Information that is entered in chronological order supports the physician/provider with maintaining continuity of patient care.

Duplicate carbonless pads:

This style allows you to provide a copy of the communication (message) to a colleague, and retain a copy for your records.

Consider customizing the form to meet your specific needs.

Print version

Caller: _________________________ Date: ____/____/____  AM    PM  

Patient: _____________________________ Phone: _________________________

Complaint/Message: __________________________________________________
____________________________________________________________________

Advice: _____________________________________________________________
____________________________________________________________________

Allergies:_____________________________________ Age: __________________
Rx: ________________________________________________________________
Pharmacy: __________________________ Phone:______________________________
Signature: __________________________