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Patient Requests for Accounting
of Disclosures (Form # 106)

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The patient who requests an "Accounting of Disclosures" will be asked to complete this form that requires the patient to provide the purpose of the requests, the dates requested, etc. The form, retained in the patient's medical record, also allows you to record the date you comply with the requests.

Description

Pkg Qty

Price/Pack

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Patient Request for Accounting of Disclosures (Form #106)

100

$14.95


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