Call Us: 1.631.364.9990 | Send us a Fax: 1.631.364.9989

HIPAA Request for Confidential Communications Form – 108

Request for Confidential Communications – 108

HIPAA Request for Confidential Communications Form – 108

$18.49

Request for Confidential Communications Form 108

100 sheets to a package – Sold by the package.

Product Description

HIPAA Request for Confidential Communications Form 108

HIPAA Form #108

The patient who requests that all or part of his PHI be kept confidential will be asked to complete the HIPAA Request for Confidential Communications Form 108, that requires the patient to outline specific communication requests. This may include alternate addresses, phone numbers and/or instructions to keep PHI confidential with family members or other individuals. The form is retained in the patients medical record.

Additional Information

Weight 2 lbs
Dimensions 12 x 8 x 1 in