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Explore all the solutions you can create with Paperform: surveys, quizzes, tests, payment forms, scheduling forms, and a whole lot more.
See all solutions
Connect with over 2,000 popular apps and software to improve productivity and automate workflows
See all integrations
Losing personal belongings during a medical procedure adds unnecessary stress to an already sensitive time. Whether it's jewelry, glasses, a phone, or clothing, patients deserve a clear, efficient process to report and reclaim their items. Our Outpatient Surgery Center Lost Item Claim Form provides healthcare facilities with a professional, HIPAA-compliant solution for managing lost property claims.
Outpatient surgery centers, ambulatory surgical centers (ASCs), and day surgery facilities see hundreds of patients each week moving through pre-op, operating rooms, and recovery areas. With so many touchpoints and staff changes throughout the day, personal items can easily be misplaced. A structured digital form ensures:
This template is specifically designed for outpatient surgery centers and includes fields that matter most in a clinical setting:
The form uses conditional logic to streamline the experience—patients only see relevant follow-up questions based on their selections, making it faster to complete even when they're recovering or stressed.
This form is ideal for:
With Paperform's HIPAA-alternative secure infrastructure and SOC 2 Type II compliance, this template provides the security and professionalism healthcare organizations require. While Paperform is not HIPAA compliant, it offers enterprise-grade security suitable for non-PHI administrative processes.
Once a claim is submitted, you can use Stepper (stepper.io) to automatically:
This automation means your front desk staff can focus on patient care while the system handles routing, tracking, and follow-up communications.
In healthcare, every touchpoint matters. When patients lose something valuable during a procedure, how you respond impacts their entire perception of your facility. A professional, easy-to-use lost item claim form shows you take their concerns seriously and have systems in place to help.
Paperform makes it simple to match this form to your facility's branding—add your logo, use your brand colors, and embed it directly on your patient portal or website. Submissions are stored securely and can be accessed by authorized staff members with role-based permissions.
This template is ready to use out of the box, but you can easily customize it to fit your facility's unique needs. Add custom disclaimers, adjust the item categories, or integrate with your existing patient management systems. With Paperform's doc-style editor, updates take minutes, not hours.
Whether you're a small outpatient center or a large multi-location ASC network, this lost item claim form helps you provide better patient care while reducing administrative overhead. Start recovering lost items faster and give your patients peace of mind when they need it most.