ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
$66.79
1
Highlights
View all details
- Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
- HIPAA compliant
- Size: 8 1/2" x 11"
MADE IN AMERICA
ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
Item #: 398026Model #: A1354
No reviews yet
$66.79
200/pack
Free Returns
Online. In store. Always free.
Learn More
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
No reviews yet
Price is $20.59
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Customers bought together
About this product
ComplyRight Patient acknowledgment of receipt of privacy practices notice measures 8 1/2" x 11".
ComplyRight Patient acknowledgment of receipt of privacy practices notice is attorney approved form acknowledging patient's information to be released to an authorized third party. Notice measures 8 1/2" x 11".
- Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
- HIPAA compliant
- Size: 8 1/2" x 11"
- Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
- HIPAA compliant
Frequently bought together
Price is $6.89
Next-Day Delivery by tomorrow
1
1
2
3
4
5
6
7
8
9
10
Price is $129.99, Regular price was $299.99, You save 56%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $49.99, Regular price was $129.99, You save 61%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $59.99, Regular price was $89.99, You save 33%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $4.49
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
Price is $34.99, Regular price was $68.99, You save 49%
Unit of measure 4000/Carton
Next-Day Delivery by tomorrow
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $2.69
Price per unit $2.69/Folder
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
Price is $329.99, Regular price was $529.99, You save 37%
Free delivery by Fri, Oct 10
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $549.99, Regular price was $879.99, You save 37%
Free delivery by Wed, Oct 15
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $349.99, Regular price was $579.99, You save 39%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $16.99, Regular price was $26.14, You save 35%
Unit of measure 1500/Carton
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $6.99, Regular price was $9.44, You save 25%
Unit of measure 500/Ream
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $14.99, Regular price was $20.59, You save 27%
Unit of measure 100/Box Price per unit $0.15/File Folder
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $39.99, Regular price was $79.99, You save 50%
Unit of measure 5000/Carton
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $297.49
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $7.99
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
Price is $649.99, Regular price was $899.99, You save 27%
Free delivery by Fri, Oct 10
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $109.99, Regular price was $179.99, You save 38%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Compare similar items
| Attributes | ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354) | ComplyRight Notice of Privacy Practice, 100/Pack (A1349) | ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211) | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) |
|---|---|---|---|---|---|
Your product ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354) Price is $66.79 |  Price is $36.19 |  Price is $165.79 |  Price is $29.39 |  Price is $66.89 | |
| Reviews | |||||
| Delivery Information | Free delivery by Fri, Oct 17 | Free delivery by Fri, Oct 17 | Free delivery by Fri, Oct 17 | Delivery by Mon, Oct 20 | Free delivery by Wed, Oct 15 |
| Available in my store | No | No | No | No | No |
| Width in Inches | 8.5 | 8.5 | 9.375 | 8.5 | 8.5 |
| Length in Inches | 11 | 11 | 11.75 | 11 | 11 |
| Medical Form Type | Privacy Practice | Privacy Practice | Medical Records Folders | Health Insurance Claims | Dental Claims |
| Form Size | 8 1 / 2" x 11" | 8 1 / 2" x 11" | 9.375" x 11.75" | Data not available | 8-1 / 2" x 11" |
| Medical Form Pack Size | 200 | 100 | 25 | 500 | 1000 |
| True Color | White | White | Data not available | Data not available | White |
| Pack Qty | 200 | 1 | 1 | Data not available | Data not available |
| Print Type | Inkjet / Laser | Data not available | Data not available | Laser | Laser |
| Series or Collection | Patient Acknowledgment of Receipt | Data not available | ComplyRight | Data not available | 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 |
Featured Products
Price is $20.19
Delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $11.59
Delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $52.19
Unit of measure 50/Pack
Free delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $16.49
Unit of measure 100/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $21.95
Delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $52.59
Unit of measure 50/Pack
Free delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $26.49
Unit of measure 50/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $15.99
Unit of measure 10/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $33.29
Delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $166.39
Free delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $59.59
Free delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $16.79
Unit of measure 100/Pack
Delivery by Tue, Oct 14
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Price is $57.29
Free delivery by Fri, Oct 17
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30