Home > MEDICAL / CHIROPRACTIC > Medical Forms > HIPAA Forms >

Privacy Patient Sign-In
Privacy Patient Sign-In


 
Alternative Views:


FREE SHIPPING! Buy 3 packs of this Item and get FREE SHIPPING!

Are you getting the best value for your Patient Sign-In Sheets?
  • With ACS you get 27 sign-in positions per sheet a total of 3,375 patient sign ins per pack.
  • If you use a 20 sign in sheet that's 875 more sign-ins per pack of 125 which = 7 packs of 20.
  • If you use a 23 sign in sheet that's 500 more sign-ins per pack of 125 which = 4 packs of 23.
  • If you use a 25 sign in sheet that's 250 more sign-ins per pack of 125 which = 2 packs of 25.
  • That's as many as 7 packs for free. More value for your Dollar.

First Time Buyers use this Code FTB-1995 to receive a 10% Discount on This Product, just type the code into the coupon box at check out and hit apply.
List Price: $198.00
Your Price: $128.00
You Save $70.00!
Unit Qty: 250
Unit: pack
Overall Dimensions: 8-1/2" W x 11"


Product Code: 14037

Shipping

Shipping Charge*:
Order 1 - 2 Boxes or Packs Shipping Cost is $15.95
Order 3 or More Boxes or Packs Shipping is FREE!

Qty:  
Description Freight, Returns & Sales Tax Policies
 
The ACS Patient Sign-In Sheets have 27 sign in positions! Color is Light Green.

Are you getting the best value for your Patient Sign-In Sheets?
  • With ACS you get 27 sign-in positions per sheet a total of 3,375 patient sign ins per pack.
  • If you use a 20 sign in sheet that's 875 more sign-ins per pack of 125 which = 7 packs of 20.
  • If you use a 23 sign in sheet that's 500 more sign-ins per pack of 125 which = 4 packs of 23.
  • If you use a 25 sign in sheet that's 250 more sign-ins per pack of 125 which = 2 packs of 25.
  • That's as many as 7 packs for free. More value for your Dollar.


Instructions on how to use this form are printed on the back of each form.
Colors & Features
  • How to Use This Form:
    • The 27 patient signature lines are a peel off adhesive label.
    • The Signature labels are numbered 1-27.
    • Patient signs in on the next available signature line
    • Their information is transferred through a carbonless sheet to a patient log sheet on the back of the form.
    • If you use the number to call the patient back to the exam room, instruct the patient after signing to remove the number from the left-hand column next to their signature line.
    • The receptionist then may peel off the precut signature line of patient information and apply it to the patient flow chart.
    • The patient information is not visible to other patients at this point. The security cover sheet (part 2 of the form) says "Please Use Next Line".
    • After completing an entire sheet or at the end of each day, separate the sheet by breaking the snap-set at the top and bottom perforations. Discard the top two sheets, you now have a complete, private list of all patients and their information. You can use these complete lists for reporting, daily audits or office records.
    Protect Your Patients' Privacy with ACS Sign-in Sheets for less than $.011 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 Salmon, Lt. Blue, Lt Green.


  • Each form has 7 columns for each patient to fill out and 27
  • 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) Number
    2) Patient Name,
    3) Appointment time,
    4) Arrival Time
    5) Appointment With
    6) New Patient check column
    7) Any changes to patient information since last visit.

Products Frequently Bought Together
Heavy Duty Vinyl Stick-On Pockets ALLERGY LABEL Times 2 Speed Cabinet 36" Wide File Shelving
Your Price: $36.00

Add
Your Price: $10.95

Add
Your Price: $4,500.00

Add
Your Price: $725.00

Add
Heavy Duty Vinyl Stick-On Pockets ALLERGY LABEL Times 2 Speed Files 36 Single Entry Letter Size 4 Post Starter Unit
Alpha Label Barkley Match End Tab Expansion Pockets Numeric Label 11 pt 2 Ply Color End Tab Folders
Your Price: $12.95

Add
Your Price: $79.00

Add
Your Price: $19.95

Add
Your Price: $235.00

Add
Barkley FABKM Match <!001>End Tab Expansion Pockets Numeric Label 11pt Reinforced Solid Color End Tab Folders
Bilingual Privacy Patient Sign-In Medi-Clip/Docu-Clip 14 pt Manila 2 Ply End Tab TAB Match Year Label
Your Price: $66.95

Add
Your Price: $42.50

Add
Your Price: $45.95

Add
Your Price: $13.95

Add
Bilingual Privacy Patient Sign-In Docuclip  Fastener Heavy Duty 14 pt Manila 2 Ply End Tab Folder Year Label
Double Ply Top Tab Pocket 11 pt Manila 2 Ply End Tab ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) Custom 8 Tab Poly Divider Set
Your Price: $59.50

Add
Your Price: $42.95

Add
Your Price: $175.00

Add
Your Price: $4.69

Add
Double Ply Top Tab Pocket Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) <!010>Custom 8  Tab Poly Divider Set
Custom 6 Tab Fileback Set ACS Sliding Lateral Track Poly Stick-On Pockets Radiology Jacket
Your Price: $3.18

Add
Your Price: $6,500.00

Add
Your Price: $24.00

Add
Your Price: $85.00

Add
<!004>Custom 6 Tab Fileback Set ACS Lateral Track Movable Shelving Systems Poly Stick-On Pockets Radiology Jacket Non-Color Coded
Outguides Custom 6 Tab Divider Set Month Label
Your Price: $79.50

Add
Your Price: $2.10

Add
Your Price: $10.95

Add
Outguides <!004>Custom 6 Tab Divider Set Month Label

Average Customer Review: Average Customer Review: 5 of 5 5 of 5 Total Reviews: 2 Write a review.

  2 of 2 people found the following review helpful:
 
5 of 5 HIPAA compliant sign in sheets August 1, 2019
Reviewer: Lee Birchansky from Cedar Rapids, IA United States  
The sheets are attractive, succinct and decently priced.

Was this review helpful to you?

  1 of 1 people found the following review helpful:
 
5 of 5 27 Sign In Postitions June 14, 2016
Reviewer: Cindy Pugh from Dallas, Texas  
We were using a similar form but it only had 20 sign in positions.  The ACS form has 27 and is a better price for same number of forms great value.

Was this review helpful to you?


Browse for more products in the same category as this item:

MEDICAL / CHIROPRACTIC
MEDICAL / CHIROPRACTIC > Medical Forms
DENTAL > Dental Forms
VETERINARY > Forms, Checks and Letterhead
Medical Forms and Books
OFFICE PRODUCTS > Forms and Books
MEDICAL / CHIROPRACTIC > Medical Forms > HIPAA Forms
MEDICAL / CHIROPRACTIC > Medical Forms > Confidential Patient Sign-In Sheets
DENTAL > Dental Forms > HIPAA
DENTAL > Dental Forms > Dental Patient Sign-In Forms
VETERINARY > Forms, Checks and Letterhead > Confidential Patient Sign-In Sheets
Medical Forms and Books > HIPAA Forms
Medical Forms and Books > Confidential Patient Sign-In Sheets
OFFICE PRODUCTS > Forms and Books > Confidential Patient Sign-In Sheets
MEDICAL / CHIROPRACTIC > HIPAA Compliant Products
MEDICAL / CHIROPRACTIC > Medical Forms > Sign-In Sheets