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Disclosure Log

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Brand Medical products
MPN 1779
Packaging 1 per each
Size 8 1/2In x 11In

    Note : Image shown for reference purposes only. Actual product appearance may vary. Please read product description for full and accurate details

    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.
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