Maintaining Compliance: Medical Documents That Need to Be Translated

Apr 1, 2020

Did you know it’s estimated that 1 in 5 people in the United States uses a different language other than English to communicate at home?

Language barriers can be difficult to cross, and this is especially true for people in the healthcare field. It can be difficult to give the best care possible to people when you don’t speak the same language.

If healthcare practitioners and insurance companies want to maintain compliance with current medical language access laws, they need to be able to provide translations for patients.

If you’re new to the world of medical language laws, you’ve come to the right place.

We’re going to give you a little background on laws you should know about, important documents that require translation, and how you can start translating important documents.

Laws to Know

If you’re serious about learning the ins and outs of medical language access laws, there are a few that you need to learn about. Laws are always evolving and changing, but the following laws are the ones that impact medical language access the most.

The Affordable Care Act (ACA)

The ACA requires that both insurers and health care practitioners provide translation and interpreting services for people with limited English proficiency (LEP).

Being in compliance with this law may go further than simply providing translated documents. In some cases, you may need to have an interpreter on hand during visits to help patients if they don’t have someone they trust that can translate for them.

Centers for Medicare & Medicaid Services (CMS)

If you provide Medicare or Medicaid services, you’re legally obligated to provide language services available to people with limited English proficiency.

It’s important to note that states aren’t required to fully reimburse providers for the cost of language services. In most cases, the costs need to be handled by insurers and medical practitioners.

Health Insurance Portability and Accountability Act (HIPAA) and Protected Health Information (PHI)

HIPAA is designed to protect the privacy of patients. It has a special focus on PHI.

Information that’s considered to be PHI refers to individually identifiable health information. This can include media histories, test results, insurance information, and even demographic data.

If you’re familiar with HIPAA compliance, it may not be a surprise to learn that they have strict laws around sharing patient information.

It’s very important for language interpreters to be intimately familiar with HIPAA laws. If an interpreter mistakenly reveals confidential information, it can put themselves, patients, and doctors at risk.

Related: Language Interpreting in Education Settings: A Growing Specialization

Documents That Must Be Translated

Now that you’re familiar with some of the laws around language translation in healthcare, we can take some time to identify key documents you’ll need to translate.

The following documents can play a pivotal role in a patient’s health, and it’s important that you find proper translation services that can help protect you and your patients.

If you want to give your patients the best services possible, make sure you find the time to ensure that these documents are translated.

Patient Information Form and Questionnaires

One of the most basic forms you deal with in your office is one of the most important pieces of paperwork patients need to have translated.

Aside from basics like contact information, it can also contain facts about a patient’s medical history, information from their last doctor’s visit, current medications and medical problems, and more.

Doctor’s offices that prefer to give patients questionnaires also need to offer translation services. If a patient misinterprets an important question on the form, you could miss out on important information that could help treat them in the future.

Rights and Responsibilities Forms

The rights and responsibilities forms for patients may be standard and short, but they’re still important to include in translation.

Be sure to state that a patient has the right to be treated with courtesy and respect at your office and that they have the right to ask questions. Let them know that they’ll be responsible for answering questions truthfully and to the best of their ability.

You can also include that they have a right to language and other translation services, but don’t go too in-depth. You can go into detail on that in a different and equally important form.

Notice of Language Assistance Services/Notice of Eligibility for Language Assistance Services

Doctor’s offices are required to provide services around language translation, but some patients may not be aware of that. It’s possible that they may have already seen doctors that didn’t offer translation services, so they aren’t aware that it’s standard to provide help.

They may also assume that translation services cost extra. Be sure to explicitly state that you offer translation services at no additional cost to regular services.

Let the patients know exactly what getting language assistant help means, and that it entails having the help of someone that speaks, reads, and writes in their chosen language along with English.

Consent and Assent Documents

Forms that fall under this category may include:

  • Release of HIPPA information

  • Consent to treatment

  • Consent to immunize

  • Consent to procedures

Every patient has the right to consent or refuse certain procedures, treatments, and medications. It’s important that they’re able to fully understand what they’re agreeing to or disagreeing with.

Intake Forms with Clinical Consequences

Is a patient about to undergo a procedure? Are they going to be under anesthesia? Do they need to understand the potential consequences and dangers of something they’re about to do?

If so, they need forms that they can understand in the language they feel the most comfortable communicating in.

Instructions for Patients

Whether your patient has a rigorous after-care plan after a procedure or new instructions for medications, they need to be able to understand what you’re telling them to do.

Making sure that you leave clear and concise instructions for patients in their native language is important. If they don’t understand certain instructions, they could put themselves in danger.

Progress Documents

Patients need to understand how they’re doing so they can make informed decisions about their healthcare. Documentation that shows how a patient is progressing in their treatment is important.

Having documents translated into your patient’s native language can make it easier for them to understand how you’re treating them.


A waiver should be considered a legally binding document that can have major consequences for both doctors and their patients.

It’s absolutely crucial that patients understand if they’re waiving the right for different treatments, the right to sue you, or other rights before they agree to any treatments or procedures.


Some doctors view complaint forms as automatically problematic. The truth is that a complaint form can help you improve your services and ensure that your patient has their concerns heard.

A complaint from a patient could let you know that you have to improve certain aspects of your business. You may even find that their complaint was a simple misunderstanding you can resolve.

What Languages Must Forms Be In?

This is a question that’s going to be difficult to answer since the outcome will depend on where you live.

If you live in an area that has a predominantly hispanic population, forms in Spanish may help your practice. It’s also possible that you may practice in an area that caters to people that speak French, Urdu, Mandarin, Portuguese, or a different language.

The truth is that you’ll never know who will walk into your office needing treatment. Having multiple language translations of your most important forms can come in handy.

Who Should Translate Forms?

Having someone on your staff that’s bilingual in a different language can be helpful, but it may not be enough when you’re translating forms.

Remember, someone may know a language conversationally, but that doesn’t mean that they’re experts in translation.

It’s best to find an expert that’s trained in English, a target language, and is familiar with HIPAA laws to protect the privacy of your patients and your practice.

How to Get Forms Translated

If you’re in need of translation services, look for a professional that can handle the work.

It’s important to not hire just any translator. Find one that specifically specializes in medical translation services.

People that are experts in medical translation understand HIPAA laws and can ensure that their work is compliant with the latest standards.

Related: The Importance of Easily-Accessible Interpretation & Translation Services

Maintain Compliance in Language Today

Being aware of the latest laws around patient care and language can do more than help you maintain compliance legally. When you break down the language barrier between doctors and patients, you provide better services.

If you’re ready to offer the best translation services to your patients, we’re eager to help. Be sure to contact us today so we can start a discussion about the best ways to help your patients and practice.

Are you curious about other ways you could improve the patient experience for people that don’t speak English as their primary language? Read our post on how to overcome the language barrier in the doctor’s office.

Liberty and the Community