a 2-hole punched permanent record

HIPAA Form

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Patient Disclosure Authorization HIPAA

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Part Number: DIS100

Availability: In Stock. Free Shipping.

Feature: 50 Forms per unit

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Protect your practice and avoid privacy disputes with this clear, step-by-step form authorizing release of patient information.

Personalization includes: Includes your imprinted practice name, address, and phone number, up to 5 lines. 2-part form provides a patient copy and a 2-hole punched permanent record.

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