examine the functionality of a patient intake form, and offer improvements.

Technology in health care continues to advance, yet there is still a time and place for paper documentation. One of the most common paper documents is a patient intake form. For this week’s assignment, you will examine the functionality of this type of documentation, and offer improvements.

For this assignment, you will create a patient registration form. You may use an existing form as a guide, and make revisions as necessary when creating your document.

  • Your form should be one page in length, formatted in a clean, professional manner.
  • Key data that will be used in EMR reporting should be in boldface text.
  • On a separate page, briefly summarize why each of the key data points are important for reporting purposes.
  • A minimum of three references, in APA format, should be included on a separate page. Sources may include forms used to create your document.

Please review the rubric to ensure that your assignment meets criteria.


  • Patient Registration Form
  • Document with the summary of the data points