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HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
WITH ADHESIVE PEEL-OFF STRIPS
(HIP02)
Our most popular HIPAA form, HIP02, now comes in 3 colors!
and a Bi-Lingual, English/Spanish Version
(Blue Only)
Our HIPAA compliant sign-in form HIP02 is now available in three colors. The standard background color is blue, but green and burgundy
are also available at no extra cost. This is a great option for multiple office locations or departments.
How it works:
Each of the 25 signature lines is an adhesive label. The labels are numbered 1-25. When the patient signs in, the information is transferred through a carbonless sheet to a patient log sheet on the back of the form for the desk attendant to access. The attendant then peels off the label revealing an information blocking sheet that says "Please Use Next Line". This new feature guides the next patient to sign in on the appropriate line. The label can then be removed and attached to the patient's file to keep a history of his or her visits. No information is visible to the patients.
Each pack contains 125 sign-in forms – enough to see 3,125 patients! |
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CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST |
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CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST |
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CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST |
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HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS WITH ADHESIVE PEEL-OFF STRIPS (HIP04)
BI-LINGUAL (English/Spanish), BLUE ONLY |
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CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST |
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Our HIP03 Generic Sign-In form is not geared specifically toward medical practices, but is designed to be used by any type of business that requires
confidentiality for their clients. Non-medical clinics such as weight-loss, law offices and secure military offices are just some of the businesses that can benefit from using this form.
The HIP03
Generic Sign-In form has 20 peel-off signature lines. It works exactly like the HIP02 by transferring the visitor's information to the log sheet on the back of the form. Once the signature label is removed
the information can only be seen by the desk attendant.
HIP03 comes in boxes of 200 forms. |
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CALL US
TOLL FREE AT:
1-877-840-1500
Our Office Hours ar
8-5 Mon.-Fri. CST |
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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
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HIPAA Employee Training Record (Form #101) |
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HIPAA Practice Training Record (Form #102) |
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Protected Health Information (PHI) Access Log (Form #103) |
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Protected Health Information (PHI)
Disclosure Log (Form #104) |
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Patient Request for Amendment of
Health Information (Form #105) |
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Patient Requests for Accounting of Disclosures (Form # 106) |
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Patient Request to Inspect / Review PHI (Form #107) |
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Patient Request for Confidential
Communications (Form #108) |
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Patient Request for Restrictions on Use
& Disclosure of PHI (Form #109) |
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Protected Health Insurance (PHI) Tracking Log (Form #110) |
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Authorization to Release Information (Form #111) |
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Notice of Privacy Practices (Form #120)
(includes acknowledgement) |
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ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY
MEDICARE, THE HEALTH CARE FINANCE ADMINISTRATION AND THE INSURANCE INDUSTRY. |
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