Medical Forms, Health Insurance Claim Forms, CMS1500, UB92, Hospital Claim Forms

HIPAA -Confidential Communications

HIPAA -Confidential Communications

HIPAA - For Confidential Communications:
The patient may request alternate means of communication. For example, a patient may request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

Format:
8.5" x 11", 1 Part with black ink- Blue "Void" security background. 5 hole punch left and 2 top for insertion in charts. Packaged in 100'S


View Sample
JPEG		For Confidential Communications
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