Form Design Requests

Jefferson has outsourced form design to an external company, Taylor Communications (formerly Standard Register). Jefferson’s Print Center will continue to print most of the forms.

Per Taylor Communications’ Service Level Agreement, you can expect to receive a proof per the following:

• New form request: 4 days
• Rework/redesign form: 2 days
• Correction to form: 1 day

To edit an existing form or to submit a new form to be designed, please click the button below and complete the Form Request form.

Submit your form request

To order reprints of an existing form, please go to http://tjuh2.jeffersonhospital.org/forms.

Forms will be uploaded to the Forms Library by the Solution Center.

Rush Requests

If you require a faster turnaround than listed above, please put a note on the submission form in the “Additional Information” area.

Hospital Medical Record Form Requests

Before starting the process of creating or revising a hospital medical record form, please contact Rosa Andrews in Health Information Management (HIM) at 215-955-5384.

What to Submit with your Request

New Form

• Provide a draft in Word or Excel

New Form based off of an existing form* (attach one of the following)

• A marked-up/commented PDF noting the changes
• Marked-up hard copy that is scanned to PDF or as an image

Revising an Existing Form* (attach one of the following)

• Provide a draft in Word or Excel
• A marked-up/commented PDF noting the changes
• Marked-up hard copy that is scanned to PDF or as an image

*VERY IMPORTANT: You must attach a PDF of the existing form from the Forms Library.

How to Submit Your Request

Non-Medical Record Forms

1. Complete and submit the online request with your proposed draft.
2. You will receive an email from Taylor Communications with instructions to view/edit/approve your form.
3. Taylor Communications will e-mail the final PDF to IS&T.
4. IS&T will upload the final PDF to the Forms Library and notify you via e-mail.
5. Order printed forms through the Forms Library.

Hospital Medical Record Forms

All medical record forms must be presented and reviewed by the Medical Records Committee (MRC) and the Medical Executive Committee (MEC). Before starting the process of creating or revising a hospital medical record form, please contact Rosa Andrews in Health Information Management (HIM) at 215-955-5384 to schedule a department representative to present at the next MRC meeting.

1. Contact Rosa Andrews, 215-955-5384, to be placed on the agenda for the next MRC meeting.
2. Complete and submit the online request with your proposed draft.
3. You will receive an email from Taylor Communications with instructions to view/edit/approve your form.
4. Once you are satisfied with the proof, e-mail the PDF to Rosa Andrews.
   1. If MRC approves your form with no edits:
      1. Rosa will forward your form to the MEC.
      2. Rosa will notify you once the form is approved by the MEC.
   2. If MRC approves your form with edits:
      1. Refer to the instructions per Taylor Communications’ email to provide edits and review a new proof.
      2. Once you are satisfied with the new proof, e-mail the new PDF to Rosa Andrews.
      3. Rosa Andrews will forward your form to the MEC.
      4. Rosa Andrews will notify you once the form is approved by the MEC.
5. Refer to instructions per Taylor Communications’ email to approve a final draft.
6. Taylor Communications will e-mail the final PDF to IS&T.
7. IS&T will upload the final PDF to the Forms Library and notify you via e-mail.
8. Order printed forms through the Forms Library.