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DFL Enterprises, Inc.
CMS/HCFA Forms
UB-04 Forms
HIPAA Compliance Forms
Envelopes
Printing Services
Login Account
0
0
CMS/HCFA Forms
UB-04 Forms
HIPAA Compliance Forms
Envelopes
Printing Services
Login Account
HIPAA Compliance Forms Patient Request for Confidential Communications (Form #108)
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Patient Request for Confidential Communications (Form #108)

$35.00

The patient may request alternate means of communication. For example, a patient may request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

  • 100 Per Case

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The patient may request alternate means of communication. For example, a patient may request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

  • 100 Per Case

The patient may request alternate means of communication. For example, a patient may request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

  • 100 Per Case

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American HCFA Forms

ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.OUR FORMS HAVE BEEN APPROVED BY THE GOVERNMENT.
The American HCFA Forms division of DFL Enterprises, Inc. is an independent supplier of US Government approved claim forms and NOT an affiliate of CMS (www.cms.gov)

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