HIPAA sign-in forms

A Division of American HCFA Forms

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Your best and fastest source for HIPAA Compliance Forms
 Form solutions that make you confident that
you are in compliance with HIPAA regulations.

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HIPAA SIGN-IN FORM
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HIPAA Links
& Information

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POLICY

HIPAA Compliant
Confidential
Patient Sign-In
Systems

At patient sign-in

Make one HIPAA
privacy worry

Click on the Links Below for Prices, Pictures and Information

HIPAA Form #101

HIPAA Form #102

HIPAA Form #103

HIPAA Form #104

HIPAA Form #105

HIPAA Form #106

HIPAA Form #107

HIPAA Form #108

HIPAA Form #109

HIPAA Form #110

HIPAA Form #111

HIPAA Form #120

Stay HIPAA Compliant...with forms specially designed to meet HIPAA Requirements!

As of April 14, 2003 HIPAA requires that healthcare practices take certain steps, and provides for steep penalties for those that do not comply. Under HIPAA, Patients are now given new fundamental rights, including:
  • the right to inspect and/or obtain copies of their medical record
  • the right to request amendments to their record
  • the right to request restrictions on the disclosure of their protected health information
  • the right to ask practices to communicate with them in a certain manner
  • the right to ask practices for a log of who has accessed their protected health information

Here's a simple answer to patient confidentiality at sign-in.

Our forms were created with the understanding that running a healthcare practice is a difficult job, and that added burdens practices can have serious negative effects. Best of all, the forms are easy to use, and will help meet the new federal requirements.

Use these forms to:
- Comply with Federal HIPAA Privacy Regulations
- Document & track information necessary to show that you are HIPAA compliant
- Integrate easily with your existing medical record system
- Help simplify administrative processes
- Ensure that patients privacy rights are not violated
  More HIPAA Information

WE HAVE HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
WITH ADHESIVE PEEL-OFF STRIPS AND GENERIC PATIENT SIGN-IN SHEETS AVAILABLE IN OUR ON-LINE STORE

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HIPAA Compliant Confidential Patient Sign-In Systems

For an Easy Tour of how HIPAA Sign-In Systems
Work Sheet by Sheet Click Here

Only $49.95/package
Enough for 1000 Patients
 Each package contains 40 sets. Each set has 25 slips so one package will be sufficient for 1,000 patients.  The pegboard binders are reusable and are designed specifically for use with our patient sign-in systems.

Description

Sets/Pack

Price/Pack

Confidential
Patient
Sign-In
System
 (without binder)

40 sets
for 1,000 patients

$49.95

Binder

1 Binder

$75.00

You can also order by Phone or Online:

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TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST

Order HIPAA
forms online

WE HAVE HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
WITH ADHESIVE PEEL-OFF STRIPS AND GENERIC PATIENT SIGN-IN SHEETS AVAILABLE IN OUR ON-LINE STORE

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HIPAA Employee Training Record (Form #101)

  A record of the HIPAA programs attended by the employee, number of hours attended, location, etc. Retain form in individual employees' personnel file.

Description

Pkg Qty

Price/Pack

HIPAA Employee Training Record Logs (Form #101)

25

$5.50

You can also order by Phone or Online:

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8-5 Mon.-Fri. CST

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HIPAA Practice Training Record (Form #102)

  A record of each HIPAA educational program you provide for employees. Includes title of program, number of hours, and attendees. Retain form in your HIPAA Compliance Manual.

Description

Pkg Qty

Price/Pack

HIPAA Practice Training Record Logs (Form #102)

25

$5.50

You can also order by Phone or Online:

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TOLL FREE AT:
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Protected Health Information (PHI) Access Log (Form #103)

  Allows you to track "uses" of PHI in each individual patient medical record. Form includes date, name and title of employee accessing the patient medical record and the reason for access.

Description

Pkg Qty

Price/Pack

Protected Health Information (PHI) Access Logs (Form #103)

250

$34.95

You can also order by Phone or Online:

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TOLL FREE AT:
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8-5 Mon.-Fri. CST

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Protected Health Information (PHI)
Disclosure Log (Form #104)

  As required by HIPAA, you must track to whom disclosures of PHI are made. This form, retained in each patient's medical record, includes the pertinent information that should be recorded when disclosures are made. This form will be photocopied for patients who request an "Accounting of Disclosures."

Description

Pkg Qty

Price/Pack

Protected Health Information (PHI) Disclosure Logs (Form #104)

250

$34.95

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TOLL FREE AT:
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8-5 Mon.-Fri. CST

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forms online

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Patient Request for Amendment of
Health Information (Form #105)

  The patient who requests that an amendment be made to his record will be asked to complete this request. It contains all elements necessary for the provider to make a decision to grant or deny the request. The form is retained in the patient's medical record.

Description

Pkg Qty

Price/Pack

Patient Request for Amendment of Health Information (Form #105)

100

$14.95

You can also order by Phone or Online:

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TOLL FREE AT:
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8-5 Mon.-Fri. CST

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forms online

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Patient Requests for Accounting of Disclosures (Form # 106)

  The patient who requests an "Accounting of Disclosures" will be asked to complete this form that requires the patient to provide the purpose of the requests, the dates requested, etc. The form, retained in the patient's medical record, also allows you to record the date you comply with the requests.

Description

Pkg Qty

Price/Pack

Patient Request for Accounting of Disclosures (Form #106)

100

$14.95

You can also order by Phone or Online:

CALL US
TOLL FREE AT:
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8-5 Mon.-Fri. CST

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Patient Request to Inspect / Review PHI (Form #107)

  The patient who requests to inspect or review protected health information will be asked to complete this form that requires the patient to provide information regarding which information and/or dates are being requested. The form, retained in the patient's medical record, also allows you to record when and how the records are reviewed, if the review is denied, the reason for the denial and the denial notification date.

Description

Pkg Qty

Price/Pack

Patient Request to Inspect Protected Health Information (Form #107)

100

$14.95

You can also order by Phone or Online:

CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST

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forms online

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Patient Request for Confidential
Communications (Form #108)

  The patient may request alternate means of communication. For example, a patient may request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

Description

Pkg Qty

Price/Pack

Patient Request for Confidential Communications (Form #108)

100

$14.95

You can also order by Phone or Online:

CALL US
TOLL FREE AT:
1-877-840-1500
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8-5 Mon.-Fri. CST

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Patient Request for Restrictions on Use
& Disclosure of PHI (Form #109)

  The patient who requested that all or part of his PHI be restricted through use (within your practice) or through disclosure (to outside entities) will complete this form. The patient will provide specific information on WHAT he wants restricted and FROM WHOM. The form, retained in the patient's medical record, allows you to record when and how this request is granted, denied and/or terminated.

Description

Pkg Qty

Price/Pack

Patient Request for Restrictions on Use & Disclosure of PHI (Form #109)

100

$14.95

You can also order by Phone or Online:

CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST

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forms online

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Protected Health Insurance (PHI) Tracking Log (Form #110)

  This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: Request to Inspect/Copy, Request for Restrictions, Request for Confidential Communication, Request for Amendment, and Request for Accounting of Disclosures. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.

Description

Pkg Qty

Price/Pack

Protected Health Insurance (PHI) Tracking Log (Form #110)

100

$14.95

You can also order by Phone or Online:

CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST

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forms online

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