HIPAA sign-in forms

A Division of American HCFA Forms

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you are in compliance with HIPAA regulations.

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HIPAA COMPLIANT CONFIDENTIAL PATIENT SIGN-IN SYSTEM
(HIP01)


HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS WITH ADHESIVE STRIPS
(HIP02) Blue
(HIP02GN) Green
(HIP02BY) Burgundy
(HIP04) Bi-Lingual, English/Spanish

HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
GENERIC
(HIP03)

HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
NON-MEDICAL
(HIP05)

HIPAA Employee Training Record
HIPAA Form #101

HIPAA Practice Training Record
HIPAA Form #102

Protected Health Information (PHI) Access Log
HIPAA Form #103

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

Patient Request for Amendment of
Health Information
HIPAA Form #105

Patient Requests for Accounting of Disclosures
HIPAA Form #106

Patient Request to Inspect / Review PHI
HIPAA Form #107

Patient Request for Confidential
Communications
HIPAA Form #108

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

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

Authorization to Release Information
HIPAA Form #111

Notice of Privacy Practices
HIPAA Form #120

Notice of Privacy Practices
Spanish Version
HIPAA Form #120S

HIPAA INFORMATION

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Confidential Patient Sign-In System (HIP01)

Click on all 3 Views and Patient's Slip of our Confidential Patient Sign-In System

View 1

View 2

View 3

Patient's Slip

At patient sign-in

HIPAA sign-in sheets

now you see it...

HIPAA sign-in sheets

now you don't...

Make one HIPAA privacy worry

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

Patients no longer see the previous patients' names when signing-in.hippa sign-in forms
Office personnel have the option to refer to patients by number rather than by name.

When the patient signs in, the information is transferred via carbonless paper to a master log sheet for office use.

The patient takes the sign-in slip.

The patient's confidential information is concealed behind the carbonless paper. The log also tracks the number on the patient's slip.

When the patient is called, the attendant reads the log and calls the patient by the slip's number.

patient sign-in sheets

Only $51.00/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 HIP01.

NATIONWIDE DELIVERY

ORDER SECURE
ON-LINE BELOW
from our on-line store at
AmericanHCFAForms.com
the #1 supplier of HCFA Forms
since 1998.

We Accept:

  The American Hospital Association has enacted the Health Insurance Portability and Accountability Act (HIPAA), mandating new ways to handle patient information that will protect patient privacy.  Protecting your patients' privacy at sign-in, where the identity of each patient must be kept confidential can be simple, efficient and affordable with our confidential HIPAA patient sign-in systems.

  Under the new HIPAA privacy standards, a method of sign-in must be in place so patients can't see other patients names/information.  What's more, office personnel must refer to patients by number rather than by name.  Read More

Description

Sets/Pack

Price/Pack

Secure Order

Confidential
Patient
Sign-In
System
(without binder)
(HIP01)

40 sets
for 1,000 patients

$51.00

Binder
Compatible with HIP01 only
Click Here
to See Image

1 Binder

$50.00

OR CONTACT 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
(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!

 

HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
WITH ADHESIVE PEEL-OFF STRIPS
(HIP02) BLUE (Standard Color)

Tell Me How It Works
CLICK HERE

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
with Adhesive Peel-Off Strips
(HIP02)
Blue

125

$49.95

You can also order by Phone

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
(HIP02GN) GREEN

Tell Me How It Works
CLICK HERE

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
with Adhesive Peel-Off Strips
(HIP02GN)
Green

125

$49.95

You can also order by Phone

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
(HIP02BY) BURGUNDY

Tell Me How It Works
CLICK HERE

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
with Adhesive Peel-Off Strips
(HIP02BY)
Burgundy

125

$49.95

You can also order by Phone

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
GENERIC (HIP03)

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.

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
Generic
(HIP03)

200

$80.00

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HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS WITH ADHESIVE PEEL-OFF STRIPS (HIP04) BI-LINGUAL (English/Spanish), BLUE ONLY

Tell Me How It Works
CLICK HERE

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
with Adhesive Peel-Off Strips
(HIP04)
Bi-Lingual
Blue Only

125

$49.95

You can also order by Phone

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

 

HIPAA CONFIDENTIAL PATIENT SIGN-IN SHEETS
WITH ADHESIVE PEEL-OFF STRIPS
NON MEDICAL SIGN-IN FORM (HIP05)

An alternative to our Generic Sign In Form. The HIP05 is a basic sign in form, easily completed by the user while protecting their privacy. Perfect for offices that do not require insurance information. The form works exactly like the HIP02 with 25 peel-off adhesive strips on each form. The information entered by the user is transferred to the log sheet on the back of the form which prevents the next user access to the information once the label is peeled off.

125 forms per pack

Description

Quantity/Case

Price/Case

Secure Order

Confidential Sign In Log
Non Medical
(HIP05)

125

$49.95

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