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  Home > MEDICAL > Medical Forms > HIPAA Forms >

  Bilingual Privacy Patient Sign-In
Bilingual Privacy Patient Sign-In


 
FREE SHIPPING!
Buy 3 packs of this Item and get FREE SHIPPING!
Less than 3 packs Flat Shipping Rate $9.95
List Price: $65.00
Our Price: $39.50
You save $25.50!
Unit Qty: 125
Unit: pack
Overall Dimensions: 8-1/2" W x 11"

Product Code: W-PS-BL-1

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Description
 
125 per pack - Bilingual Privacy Patient Sign-In  25 positions for Patients to fill personal information on removable strip.
Protect Your Patients' Privacy with
ACS Sign-in Sheets for less than $.012 per patient sign in.


Features
  • Protect Your Spanish speaking and English speaking Patients' Privacy with the ACS Bilingual Sign-in Sheets for less than $.012 per patient sign in.

    Patients fill personal information on removable strip. Carbon sheet transfers information to the back so other patients do not see previous patient’s information Meets HIPAA Requirements
    Available in Lt. Blue

    Each form  has 7 columns for each patient to fill out and 25 patient positions to fill out on a numbered slip, when finished filling out they remove the slip and hand to the receptionist leaving a blank space on sign in sheet front page.  The information is transferred via carbon paper to a master log.  When patient removes the slip, that space is blank and the patient information is protected behind the carbon paper, available only for office use.

    Columns:

    1) Patient Name,
    2) Arrival time,
    3) Appointment time,
    4) Name of staff appointment is with,
    5) New patient check column
    6) Any changes to patient information since last visit.
    7) Insurance Change

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