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Specification
Brand : NEBS
BulletPoint : Simple 2-sided dental registration forms allow you to register patients with ease. A short history section is included - perfect for a speedy check-in process!
BulletPoint1 : PATIENT DISCLOSURE: Close compliance gaps and meet requirements for HIPAA disclosure of certain medical obligations with Medical ITG’s HIPAA Compliant Form for Patient Consent to Release Health Records & PHI. This is a easy to fill out and complete handout health care providers can give to their patients.
BulletPoint2 : COMPLIANT: The Medical ITG form, created by industry professionals and HIPAA compliance experts, will ensure that medical, healthcare, and mental health practices are 100% compliant with all workplace regulations.
BulletPoint3 : HIPAA FACTS: HIPAA requires medical providers to obtain written authorization for any use or release of protected health information that is not for treatment, payment, health care operations. Including any medical information otherwise permitted or required by the HIPAA Privacy Rule.
BulletPoint4 : FORM: The HIPAA Patient Release Consent Form is equipped with all the required sections and descriptions to validate an authorization sheet. The forms are in English and come 150 to a pack.
BulletPoint5 : MEDICAL ITG: Medical ITG (Information Technology Group) has been serving the medical, healthcare, and mental health community for nearly 20 years. We offer a large variety of highly specialized services and products in the industry, including HIPAA compliance forms, expert HIPAA compliance consulting, security risk assessments, policy & procedure audit and related compliance documentation.
Color : Yellow
ExternallyAssignedProductIdentifier : 00810074450584
ExternallyAssignedProductIdentifier1 : 0860000653312
ExternallyAssignedProductIdentifier2 : 860000653312
ExternallyAssignedProductIdentifier3 : 20687225320669
ExternallyAssignedProductIdentifier4 : 00687225320665
FdaDeviceClassification : iv
FdaIndicationOfUse : otc
FdaInstructionsForUseType : na
FdaLabelType : consumer
ItemName : 5Forms 15 Dental Registration Forms Two Sided Green Ledger 5 1/2 x 8 1/2"
ItemPackageDimensions_Height : 9 inches
ItemPackageDimensions_Length : 11.5 inches
ItemPackageDimensions_Width : 10 inches
ItemPackageQuantity : 1
ItemTypeKeyword : business-claim-forms
Manufacturer : NEBS
Material : Latex Free
ModelNumber : AN-2-149
NumberOfItems : 100
PackageLevel : unit
PaperSize : 8.5-x-11-inch inches
PartNumber : 15.2
ProductDescription : Simple 2-sided dental registration forms allow you to register patients with ease. A short history section is included - perfect for a speedy check-in process! Green Bond Stock w/Green Ink. 250 per box.
ProductSiteLaunchDate : 2023-07-14T16:27:37.560Z
Style : Chemistry, Beige, Tab 1
UnitCount : 100
UnspscCode : 44000000