PRV2 3 Part Notice of Privacy Practices HIPAA Acknowledgment

PRV2 3 Part Notice of Privacy Practices HIPAA Acknowledgment
Size: 5 1/2 x 8 1/2"

A clear, compact form that documents patient receipt of your privacy policy.

• Includes your imprinted practice name, address, and phone number, up to 5 lines.
• 3-part form provides copies for patient, chart and privacy officer.
• Meets HIPAA Regulations.
• 25 Forms per pad, 5 Pads minimum. (125 Forms)
  
• IMPORTANT: Your order will be on hold until you message us the Imprint you want on the form.