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Jane to Jane Chart Transfer Authorization Form Explainer

Jane to Jane transfers are when we at Jane transfer your charting data from one account to another. One part of that which everyone signs, is the Authorization Form which has a couple of parts to it.

This guide is great at going through the options for the Source Account Owner

If you’re ready for a transfer, you can also see Jane to Jane Transfer: A Detailed Guide.

What is the authorization form and why is it needed?

The authorization form is sent out to all parties involved in the transfer, from the Source Account Owner, Destination Account Owner, and the Practitioner being transferred.

Here is an example of the portion of the authorization form that is sent out. The source account owner fills out the majority of these and is able to make the selection for exactly what is transferred out of the account.

Please Note: This is only an example of a portion of the full authorization form. You must contact Jane Support for us to send out the authorization form on our side.

This is a copy of what the selection portion of an authorization form looks like.

What do each of these sections mean and who makes the selection?

The Source account owner will fill out the majority of these items, as in Jane’s eyes, they are the owner of the data in the account. Take a look at our detailed guide, linked at the top of this guide, for more information about that.

The top portion is to confirm each of the accounts that will be transferred from and to, and also the practitioners and the date the transfer should occur on. Keep in mind, transfers only occur on weekdays.

The bottom portion is for the source account owner to select, which is exactly what charts should be transferred during this process for the practitioner(s). More on that below.

Top Selection: Accounts, Practitioner(s), and Date

Original Jane Account - This is the account the charts are being transferred out of.

Jane Account for Import - This is the account the charts are being transferred to. (Entered by either the practitioner leaving or the destination account owner)

Authors of Chart Entries to be Transferred - The source account owner to enter in each of the staff members that are being transferred here, which should have been agreed upon with the Jane team prior to the form being sent so that each is included in the signing portion.

Desired Date or Transfer - The date in which the transfer should occur, which can be flexible if unknown.

Complete or Specific Set of Practitioners Charts

You have two options here, one is a Complete set of practitioners chart records or the other, Specific set of patients charts for a practitioner.

The first option if selected will direct us to transfer every chart authored by the practitioner specified in the authorization form. This will not transfer all charts in an account, only the specific practitioner getting the transfer done.

The second option is if you would only like a specific set of patients to be transferred for the practitioner.

An example of this would be two chiropractors working side by side, who treated each others’ patients while the other was on vacation. If one of the practitioners were to leave, there might be 20 out of 100 patients that aren’t directly related to the practitioner leaving, and the account owner might want to make a custom selection of who is transferred.

If you select this option, the source account must provide a Patient List with the exact patients identified to be transferred.

Second Selection, Other Charts Besides Practitioner

You can make one selection in this area to determine if other information should be transferred as well as the practitioners.

Admin-authored chart records - These are charts that a staff member who is Administrative (assigned no disciplines) has uploaded on a practitioners patients. Jane sees a practitioners patient as someone whom they have had an appointment with.

This selection can be common when administrative staff often upload things like reports or leave notes in charts for practitioners.

Intake Forms authored inside Jane

If your clinic sends out intake forms from inside of Jane to be filled out for the practitioner, if that practitioner’s patients have filled out intake forms for their appointments, those intake form questionnaires will be transferred along with the practitioner’s charts.

Both or None Selection

If selecting both of these options, you can say Both or if you only want the practitioner’s charts authored by themselves to be transferred, select None.


At the bottom, after the selections are made, each party will need to sign the authorization form.

The form goes out in pieces, first to the source account owner, then the destination account owner, and finally the practitioner(s) to sign.

If there is an additional practitioner that is listed in the above portion List practitioners to be transferred, that was not indicated to the Jane team, a new form will need to go out so that the extra practitioner(s) receive the form to sign and are indicated on the form itself.

If you have any further questions about any of this please don’t hesitate to contact us and we’d be happy to help you!