ComplyRight HIPAA Patient Consent and Authorization Form (A1350)
$54.19
1
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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Final price is $54.19
200/pack
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About this product
ComplyRight Patient consent and authorization form measures 8 1/2" x 11".
ComplyRight Patient consent and authorization form is attorney approved form acknowledging patient's information to be released to an authorized third party. Form measures 8 1/2" x 11".
- 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"
- Attorney approved form acknowledging patient's consent to release his or her protected health information to an authorized third party
- Complies with HIPAAs authorization requirements
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| Attributes | ComplyRight HIPAA Patient Consent and Authorization Form (A1350) | ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123) | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) | ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100) |
|---|---|---|---|---|---|
Your product ComplyRight HIPAA Patient Consent and Authorization Form (A1350) Price is $54.19 |  Price is $36.99 |  Price is $30.19 |  Price is $43.59 |  Price is $17.29 | |
| Reviews | |||||
| Delivery Information | Free delivery by Fri, May 29 | Free delivery by Fri, May 29 | Delivery by Mon, Jun 01 | Free delivery by Thu, May 28 | Delivery by Thu, May 28 |
| Available in my store | No | No | No | No | No |
| Width in Inches | 8.5 | 12 | 8.5 | 8.5 | 8.5 |
| Length in Inches | 11 | 18 | 11 | 11 | 11 |
| Medical Form Type | Consent | Privacy Practice | Health Insurance Claims | Dental Claims | Dental Claims |
| Form Size | 8 1 / 2" x 11" | 12" x 18" | Data not available | 8-1 / 2" x 11" | 8-1 / 2" X 11" |
| Medical Form Pack Size | 200 | Data not available | 500 | 500 | 100 |
| True Color | White | White | Data not available | White | White |
| Print Type | Inkjet / Laser | Data not available | Laser | Laser | Laser |
| Number of Parts | 1 | Data not available | Data not available | 1 | 1 |
| Pack Qty | 200 | 1 | Data not available | Data not available | Data not available |
| Series or Collection | HIPAA Patient Consent and Authorization Form | HIPAA Notice | Data not available | Data not available | Data not available |
| 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 |
