Notice of Privacy/Acknowledge of Receipt 2-Pt Form

Updated for the HIPAA Mega Rule! Describe to residents how medical information about them may be used and disclosed and who has access to the information. Includes 2-part Acknowledgement of Receipt (detachable) to quickly and easily obtain a signature and document receipt.

Briggs offers a complete line of HIPAA documentation. Also see:
Business Associate Agreement - Updated! (Stock No. 1771)
Request to Review or Obtain Copies of Protected Information (Stock No. 1772)
Authorization to Release Patient Information (Stock No. 1773 or 1773/2)
Request for Amendment of Information (Stock No. 1775)
Denial of Amendment (Stock No. 1776)
Disclosure Log - Updated! (Stock No. 1779)
Confidential Patient Sign-In Log (Stock No. 1791)

9" x 11", 4-page booklet-style form (white bond paper, printed two sides different) plus an attached 2-part carbonless form (white original, yellow duplicate, printed one side), black ink, 5-hole punched top and side, wrapped in 100s.