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Patient Privacy Sign-In System

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Product Catalog
Patient Privacy Sign-In System

Protect Your Patient's Privacy
SIZE: 8 1/2" x 11"
Patient Privacy Sign-In System
Click to enlarge
Using sign-in sheets in waiting rooms "may continue, if reasonable safeguards are taken to minimize the chance of incidental disclosure to others."
- from "Standards for Privacy of Individually Identifiable Health Information"
  (Final HIPAA Privacy Rule, Section 164.502)
  U.S. Department of Health and Human Services
  August 14, 2002

Recent HIPAA regulations require that patient privacy be protected, even in public waiting rooms. And now, compliance just got easier with our new simple, inexpensive sign-in system. This two-part "label/form" keeps patient information confidential and creates an automatic duplicate log of all patient sign-in activity.


Patient Privacy Sign-In System
Keep Patient Visits Private
Each patient completes the form's top line, a self-adhesive strip that includes a removable number to give to patients if you wish to call them by number instead of by name.

Patient Privacy Sign-In System
Update Chart
Before the next patient signs in, the receptionist removes the strip and attaches it either to a patient call sheet or into the patient's chart. The completed label alerts you to changes in patient information.

Patient Privacy Sign-In System
Verify Billing, Keep an Audit Trail
The Patient Sign-In form automatically creates a duplicate record sheet of every appointment, which you can file away or store in a binder. This log also helps you analyze wait times and better manage patient volume and flow.

Patient Privacy Sign-In System
Protect Confidentiality
The label liner allows the duplicate log to remain hidden from patients that follow. Once the form is completed, detach the edges (which discourage peeking) to discard the liner and release the log.

Place Order Below (or Contact Us to Customize)

20 entries per 8 1/2" x 11" form -- 100 sheets per box -- 2,000 entries total per box
$85 per box with duplicate log
$75 per box with NO duplicate log

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MediTape Reports - For the Best Results
Data Management, Inc.
537 New Britain Avenue, Farmington, CT 06034. Email: Fax: 800.428.1951
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