Accountable Care Organization Patient Attribution Form

Streamline ACO Patient Attribution with Paperform

Accountable Care Organizations (ACOs) need clear, compliant patient attribution processes to coordinate care effectively and meet quality benchmarks. This ACO Patient Attribution Form template helps healthcare providers, medical groups, and ACO administrators establish primary care relationships, obtain necessary consents, and explain value-based care arrangements—all in one professional, easy-to-complete form.

Designed for Healthcare Administrators and ACO Coordinators

Whether you're managing a Medicare Shared Savings Program ACO, a commercial ACO arrangement, or a state-based accountable care initiative, this template captures everything you need: patient demographics, insurance details, primary care provider selection, care team coordination preferences, quality reporting consent, and cost savings sharing acknowledgment.

The form guides patients through complex healthcare concepts in clear, accessible language while ensuring you meet CMS and payer attribution requirements. Conditional logic adapts questions based on insurance type and care preferences, creating a smooth experience that reduces confusion and improves completion rates.

Automate Patient Attribution Workflows with Stepper

Beyond just collecting attribution data, you can connect this form to Stepper to automate your entire patient enrollment workflow. Route completed attributions to your practice management system, notify care coordinators when new patients join, update your EHR with provider assignments, trigger welcome sequences, and schedule initial care planning appointments—all without manual data entry.

For organizations managing attribution across multiple provider sites or payer contracts, Stepper can route submissions to the appropriate care team, create patient records in multiple systems simultaneously, and ensure compliance documentation is properly filed. This is particularly valuable during open enrollment periods when attribution volumes spike.

Professional, HIPAA-Aware Design

Built with healthcare workflows in mind, this template uses clear section headers, helpful descriptions, and a professional design that builds patient trust. While Paperform is not HIPAA compliant, this template structure can be adapted for use in your secure healthcare systems or used for preliminary patient information gathering before transferring to HIPAA-compliant platforms.

The form includes space for explaining value-based care benefits, cost savings sharing arrangements, and quality improvement initiatives in patient-friendly language—helping you meet transparency requirements while strengthening patient engagement in their care journey.

Trusted by healthcare organizations worldwide, Paperform makes it easy to create, share, and manage complex healthcare forms without IT support. Get started with this ACO patient attribution template and modernize your accountable care enrollment process today.