3-Part Notice of Privacy Practices HIPAA Acknowledgment

Item#: PRV2 Size: 5 1/2 x 8 1/2"

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

  • Please note: 25 forms per pad - 5 pad minimum.
  • Personalization includes: Your imprinted practice name, address, and phone number, up to 5 lines. 3-part form provides copies for patient, chart and privacy officer.