Updated for the HIPAA Mega Rule! Track all disclosures of individual patient s information, including date, recipient of information, purpose, type of information, and name of employee disclosing. A disclosure key is printed at the bottom for quick reference and standardization.

Briggs offers a complete line of HIPAA documentation. Also see:
Notice of Privacy Practices / Acknowledgment of Receipt - Updated! (Stock No. 1770)
Business Associate Agreement - Updated!(Stock No. 1771)
Request to Review or Obtain Copies of Protected Information (Stock No. 1772)
Authorization to Release Patient Information (Stock No. 1773 or 1773/2)
Request for Amendment of Information (Stock No. 1775)
Denial of Amendment (Stock No. 1776)
Disclosure Log - Updated! (Stock No. 1779)
Confidential Patient Sign-In Log (Stock No. 1791)

8 1/2" x 11", white paper, printed one side, black ink, 5-hole punched top and side, padded in 100s.