UIPKGE/blocks/patient-intake-form

Patient Intake Form · UIPKGE

HIPAA-compliant new patient registration and medical history questionnaire in a SectionCard. Features a 4-step Stepper (Personal Information → Medical History → Insurance & Billing → Consent & Sign), demographic inputs with biological sex and emergency contact, chronic conditions checklist with allergy details and medication textareas, insurance carrier selection with card photo upload dropzones, regulatory HIPAA disclosure accordion with electronic signature pad, and a post-submission confirmation receipt with patient ID.

npx shadcn@latest add https://uipkge.dev/r/react/patient-intake-form.json

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patient-intake-form

Registry Items

patient-intake-form

Configuration

Name

patient-intake-form

Type

Block

Description

Files · 1

Dependencies

npm packages

lucide-react

Registry items

https://uipkge.dev/r/react/badge.json

https://uipkge.dev/r/react/button.json

https://uipkge.dev/r/react/checkbox.json

https://uipkge.dev/r/react/input.json

https://uipkge.dev/r/react/label.json

https://uipkge.dev/r/react/section-card.json

https://uipkge.dev/r/react/select.json

https://uipkge.dev/r/react/separator.json

https://uipkge.dev/r/react/stepper.json

https://uipkge.dev/r/react/textarea.json