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HIPAA Medical Records
Notice of Privacy Practice
Compare our prices to other HIPAA Notice of Privacy Practice Forms on the internet.
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Martin Berliner, Vice President Sales.

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HIPAA Notice of
Privacy PracticeForms
at
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call 1-866-696-0800

HIPAA Notice of PNGrivacy Practice Forms
Blank or Personalized with your name, address, city, state, zip code and telephone number.
HIPAA Forms Up to 40% Less than our Competitors

HIHIPAA Notice of Privacy Practices Form

Stock 20 lb. White Bond
Imprinted up to 5 lines plus effective date and privacy officer name
Printed 1 color Black Ink, 2 sides. Size: 8-1/2" x 11"

Form No. NPP-1IMP Price per lot          Personalized Notice of Privacy Practice
500
1000
2500
$112.00
$ 129.00
$210.00

Form No. NPP-1BL Price per 100 sheets       Not Personalized Notice of Privacy Practice
200
400
800
1600
2400
$ 19.00
$17.00
$15.00
$14.00
$10.00
For larger picture click here

Patient Acknowledgement
1 Part - Stock 20 lb. White Bond
Imprinted up to 5 lines
Printed 1 color Black Ink Size: 8-1/2" x 11"
Punched 2 round holes 1/4" - 2-3/4" centers
Form No. NPPA-1IMP (1 Part)   Price per lot   Personalized
500
1000
2500
$ 69.00
$ 95.00
$175.00
 
Form No. NPPA-1BL (1 Part)  Price per 100   Not Personalized
200
400
800
1600
2500
$ 10.00
$9.00
$8.00
$7.00
$6.00
For larger picture click here  

 
Patient Records Access Form
1 Part - Stock 20 lb. White Bond
Imprinted up to 5 lines
Printed 1 color Black Ink, Size: 8-1/2" x 11"
Punched 2 round holes 1/4" - 2-3/4" centers
Form No. PRAF-1IMP (1 Part)    Price per lot      Personalized
500
1000
2500
$ 69.00
$ 95.00
$175.00
 
Form No. PRAF-1BL(1 Part)  Price per 100    Not Personalized
200
400
800
1600
2500
$ 10.00
$9.00
$8.00
$7.00
$6.00
For larger picture click here  

Individual Patient Disclosure Authorization Form
1 Part - Stock 20 lb. White Bond
Imprinted up to 5 lines
Printed 1 color Black Ink,. Size: 8-1/2" x 11"
Punched 2 round holes 1/4" - 2-3/4" centers
Form No. DISC-1IMP (1 Part)     Price per lot    Personalized
500
1000
2500
$ 69.00
$ 95.00
$175.00
 
Form No. DISC-1BL(1 Part)  Price Per 100      Not Personalized
200
400
800
1600
2500
$ 10.00
$9.00
$8.00
$7.00
$6.00
For larger picture click here  

Complaint Form
1 Part - Stock 20 lb. White Bond
Imprinted up to 5 lines
Printed 1 color Black Ink, Size: 8-1/2" x 11"
Punched 2 round holes 1/4" - 2-3/4" centers
Form No. COMP-1IMP (1 Part)    Price per lot        Personalized
500
1000
2500
$ 69.00
$ 95.00
$175.00
 
Form No. COMP-1BLK (1 Part)  Price per 100        Not Personalized
200
400
800
1600
2500
$ 10.00
$9.00
$8.00
$7.00
$6.00
For larger picture click here  

Report of Non-Routine Disclosures
1 Part - Stock 20 lb. White Bond
Imprinted up to 5 lines
Printed 1 color Black Ink, Size: 8-1/2" x 11"
Punched 2 round holes 1/4" - 2-3/4" centers
Form No. NON-1IMP (1 Part)  Price per lot    Personalized
500
1000
2500
$ 69.00
$ 95.00
$175.00
 
Form No. NON-1BL (1 Part)  Price per 100     Not Personalized
200
400
800
1600
2500
$ 10.00
$9.00
$8.00
$7.00
$6.00
For larger picture click here

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

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), that mandates new ways to handle patient information that will protect privacy. One option developed protects privacy at sign-in where the identity of each patient is kept confidential.

With this simple, affordable method of sign-in in place, patients can't see other patients names and information. What's more office personnel can refer to patients either by name or number.
On a numbered slip, each patient prints Name, Arrival Time, Name of Healthcare Professional and lets the office know of any insurance or address changes since the last visit. The information is transferred via carbonless paper to a a master log. Once the patient removes the slip, the information is protected behind the carbonless paper, available only for office use.
The front desk attendant reads the log and each patient is called by name or number.

Each kit contains 40 sets, numbered 1 through 25.
Enough for 1000 patients

Form No. W-SGNKIT with binder (List $95.00)
1
2 - 5
$ 81.75 ea
$ 76.00 ea
 
Form No. W-JSGN Refill Kits no binder (List 59.90)
1 - 4
5 +
$ 51.50 ea
$ 47.00 ea
 

Custom Sign-in Sheets made to your requirements
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NY State Residents: 1-631-696-4900
Fax: 1-631-696-4901

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