Hippa Authorization For Disclosure

Item #: 40473
Hippa Authorization For DisclosureClick to Zoom In
as low as $0.87 ea
Quantity:
   Qty      Total   
   50      $63.95   
   100      $118.95   
   200      $199.95   
   500      $434.95   
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Use the HIPAA Authorization for Disclosure of Protected Health Information to document the release of protected medical information. It's ideal for medical and dental practices as well as companies that manage their own medical or dental plan.

3-part carbonless form allows you to distribute and file copies.
Size: 8 1/2" X 11"

Click here for sample


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