Patient Check In Sheet

Use of this HIPAA Check-In Sheet can help with:

• Protecting your patients privacy and your staff of any HIPAA violations
• Welcoming your patients to your office and remind them to notify staff of any insurance, address or phone number changes
• Avoiding any question of fraud from Insurance companies by maintaining a master log of all patients seen by your office
• Improved record keeping by attaching the signed removable adhesive strip to the patients chart
• Being eco-friendly as this form has a unique 2 ply design eliminating the middle sheet that needs to be disposed on the 3 ply Sign- In Sheets.

• 8-1/2 x 11-5/8 including top and bottom stubs
• 2 part carbonless forms
• Ply 1 - White Semi-Gloss label, printed in PMS 3005 Blue and Black
• Ply 2 - White CF 20 #, printed in black on the face and back (back has instructions for use).
• Sheets have 20 lines per form 125 forms per box 5 lbs. per box