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You are here: Home > MEDICAL > Medical Forms and Books > Patient Sign-In Sheets
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Protect Your Patients' Privacy with ACS Sign-in Sheets
For less than $.012 per patient sign in -

You can protect your facility from HIPAA Violations and Potential Law Suits.
No more patients saying " Oh she was here what was she here for? "

ACS sign-in sheets will be welcome in your office by your staff and patients.
ACS sign-in sheets will make your patients more comfortable and confident that you will
protect their privacy and that you care about their Patient Privacy Rights.
ACS sign-in sheets protects your Facility and staff from HIPAA violations.
ACS sign-in sheets prove when patients were in your office helping to avoid any question
of fraud from insurance companies, including Medicare and state programs, such as
Medicaid as well as allowing compliance  with federal and state privacy laws.

Each patient fills out 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.

Choose from two styles 23 patient positions 6 Columns or 25 patient positions 7 Columns
Columns: (form with 7 columns column 7 reads "Insurance Change")
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.
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Privacy Patient Sign-In Patient Sign-In Pads Medical Icons Patient Sign-In Pads Medical Icons
List Price: $60.00
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Privacy Patient Sign-In Privacy Patient Sign-In Privacy Patient Sign-In
125 per pack - Privacy Patient Sign-In  25 positions for Patients to fill personal information on removable strip. 100 Sheets per pad ACS Sign-in Sheets matches Histacount form #4079 medical icons.  3 PADS PER PACK. 100 Sheets per pad ACS Sign-in Sheets matches Histacount form #4079 medical icons
Privacy Patient Sign-In Privacy Patient Sign-In Privacy Patient Sign-In
List Price: $80.00
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List Price: $80.00
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Privacy Patient Sign-In Privacy Patient Sign-In Privacy Patient Sign-In
100 per pack - Privacy Patient Sign-In  23 positions for Patients to 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.  White w/ Smile. 100 per pack - Privacy Patient Sign-In  23 positions for Patients to 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.  White w/ Fish. 250 per pack - Privacy Patient Sign-In  23 positions for Patients to 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 Salmon, Lt. Blue & Lt. Green.
Pegboard Privacy Patient Sign-In Sheets Refills Pegboard Privacy Patient Sign-In Kit
Our Price: $69.00
Our Price: $125.00
Pegboard Privacy Patient Sign-In Pegboard Privacy Patient Sign-In Kit
Pegboard Privacy Patient Sign-In Refills enough slips to see 1,000 patients Pegboard Privacy Patient Sign-In  Kit enough slips to see 1,000 patients