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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 Protected Health Insurance (PHI) Tracking Log (Form #110)
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Protected Health Insurance (PHI) Tracking Log (Form #110)

$35.00

This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: Request to Inspect/Copy, Request for Restrictions, Request for Confidential Communication, Request for Amendment, and Request for Accounting of Disclosures. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.

  • 100 Per Case

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This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: Request to Inspect/Copy, Request for Restrictions, Request for Confidential Communication, Request for Amendment, and Request for Accounting of Disclosures. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.

  • 100 Per Case

This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: Request to Inspect/Copy, Request for Restrictions, Request for Confidential Communication, Request for Amendment, and Request for Accounting of Disclosures. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.

  • 100 Per Case

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PHONE: 985-875-0800
FAX: 985-206-5040

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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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