ComplyRight HIPAA Patient Consent and Authorization Form (A1350)
$65.09
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Highlights
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- Attorney approved form acknowledging patient's consent to release his or her protected health information to an authorized third party
- Complies with HIPAA’s authorization requirements
- Size: 8 1/2" x 11"
MADE IN AMERICA
ComplyRight HIPAA Patient Consent and Authorization Form (A1350)
Item #: 398021Model #: A1350
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Your product ComplyRight HIPAA Patient Consent and Authorization Form (A1350) Price is $65.09 | |||||
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Delivery Information | Free delivery by Mon, Jun 16 | Delivery by Wed, Jun 11 | Delivery by Tue, Jun 17 | Delivery by Mon, Jun 16 | Free delivery by Fri, Jun 13 |
Available in my store | No | No | No | No | No |
Width in Inches | 8.5 | 8.5 | 8.5 | 12 | 8.5 |
Length in Inches | 11 | 11 | 11 | 18 | 11 |
Form Size | 8 1 / 2" x 11" | 8 1 / 2" x 11" | Data not available | 12" x 18" | 8-1 / 2" x 11" |
Medical Form Type | Consent | Medical Records Folders | Health Insurance Claims | Privacy Practice | Dental Claims |
Medical Form Pack Size | 200 | 100 | 500 | Data not available | 500 |
True Color | White | White | Data not available | White | White |
Pack Qty | 200 | Data not available | Data not available | 1 | Data not available |
Print Type | Inkjet / Laser | Continuous | Laser | Data not available | Laser |
Series or Collection | HIPAA Patient Consent and Authorization Form | Data not available | Data not available | HIPAA Notice | Data not available |
Number of Parts | 1 | Data not available | Data not available | Data not available | 1 |
Price Per Unit | Data not available | Data not available | Data not available | Data not available | Data not available |
Add To Cart | Add To Cart | Add To Cart | Add To Cart |