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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? "


AC
S 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 Generic Privacy Sign-In

FREE SHIPPING / 125 per pack - Generic Privacy Sign-In  25 positions / HIPAA Compliant

List Price: $65.00
Your Price: $39.50
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Privacy Patient Sign-In Privacy Patient Sign-In

FREE SHIPPING / 27 positions / Green, Light Blue or Salmon / W-PS-14037 & APSGN / 125 per pack

List Price: $65.00
Your Price: $39.50
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(4)
Bilingual Privacy Patient Sign-In Bilingual Privacy Patient Sign-In

FREE SHIPPING / 27 positions / W-PS-BL-1 & APSGN-B / 125 per pack

List Price: $65.00
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(2)
Privacy Patient Sign-In Privacy Patient Sign-In

FREE SHIPPING / 27 positions / Green, Light Blue or Salmon / 14037 & ASPGN / 250 per pack

List Price: $95.00
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You Save $18.00!

(1)
Pegboard Privacy Patient Sign-In Pegboard Privacy Patient Sign-In Sheets Refills

FREE SHIPPING / Pegboard Privacy Patient Sign-In Refills enough slips to see 1,000 patients

List Price: $145.00
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Privacy Patient Sign-In Custom Privacy Patient Sign-In

FREE SHIPPING / 100 per pack - 1 Part Custom Privacy Sign-In  20 positions

List Price: $235.00
Your Price: $135.00
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Pegboard Privacy Patient Sign-In Kit Pegboard Privacy Patient Sign-In Kit

FREE SHIPPING /Pegboard Privacy Patient Sign-In  Kit enough slips to see 1,000 patients

List Price: $195.00
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Privacy Patient Sign-In Custom Privacy Patient Sign-In

FREE SHIPPING / 100 per pack - 2 Part Custom Privacy Sign-In  20 positions

List Price: $265.00
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Privacy Patient Sign-In Privacy Patient Sign-In Log Book

FREE SHIPPING / Privacy Sign-In Book / Spiral Bound / 5 per pack

List Price: $255.00
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Privacy Patient Sign-In Custom Privacy Patient Sign-In Log Book

FREE SHIPPING / Custom Privacy Sign-In Book / Spiral Bound / 5 per pack

List Price: $355.00
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