Form Design Request Instructions

In the long term, Jefferson is pursuing automating the form design process. In the short term, an external company, Standard Register (SR), will design forms until we automate the process. Jefferson’s Print Center will continue to print most of the forms.

Per Standard Register’s Service Level Agreement, you can expect to receive a proof per the following:


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.

Form Request

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

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

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

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

*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. A designer from Standard Register (SR) will e-mail you a proof.
    1. If edits are needed, e-mail your changes directly to your SR designer.
  3. When you approve the final proof, e-mail your SR designer with your approval.
  4. SR will e-mail the final PDF to Creative Services (formerly JeffGraphics).
  5. Creative Services will upload the final PDF to the Forms Library and notify you via e-mail.
  6. 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. A designer from Standard Register (SR) will e-mail you a proof.
    1. If edits are needed, e-mail your changes directly to your SR designer.
  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.
      3. Skip to step 5.
    2. If MRC approves your form with edits:
      1. E-mail the edits directly to your SR designer for 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. Continue to step 5.
  5. E-mail your SR designer and let him or her know that the form is approved.
  6. SR will e-mail the final PDF to Creative Services (formerly JeffGraphics).
  7. Creative Services will upload the final PDF to the Forms Library and notify you via e-mail.
  8. Order printed forms through the Forms Library.