Patient Disclosure Authorization HIPAA Form / 2 Part Carbonless / TMG154

Description: Patient Disclosure Authorization HIPAA Form / 2 Part Carbonless / TMG154 Patient Disclosure Authorization HIPAA Form / 2 Part Carbonless / TMG154 Click image to enlarge Description Patient Disclosure Authorization HIPAA Form Form Size: 8.5 x 11 Parts: 2 Benefits and Features Protect your practice and avoid privacy disputes with this clear, step-by-step form authorizing release of patient information. Personalization includes: Includes your imprinted practice name, address, and phone number, up to 5 lines. 2-part form provides a patient copy and a 2-hole punched permanent record. Affordably Priced and Professionally Printed. Please email us through ebay with any questions. Once you make your purchase on ebay, we will contact you for your business information that you would like printed. Our Policy... We offer a 100% satisfaction guarantee. We strive to provide a positive eBay buying experience! Shipping: Shipping within the Continental United States is FREE via UPS Ground Insured shipping service. Returns / Exchanges: We warrant all merchandise against manufacturers defects. Your satisfactory is Guaranteed. Images sell! Get Supersized Images & Free Image HostingCreate your brand with Auctiva's Customizable Templates. Attention Sellers - Get Templates Image Hosting, Scheduling at Auctiva.com. Track Page Views With Auctiva's FREE Counter

Price: 44.97 USD

Location: Fairless Hills, Pennsylvania

End Time: 2024-01-14T16:21:57.000Z

Shipping Cost: 0 USD