Request to Obtain Protected Information

Reviewed and complies with the HIPAA Mega Rule! Patients / Residents wanting to review or obtain a copy of protected health information must submit a request. This one-page form simplifies the process and captures all the necessary information for the provider to consider the request.

Briggs offers a complete line of HIPAA documentation. Also see:
Notice of Privacy Practices / Acknowledgment of Receipt - Updated!(Stock No. 1770)
Business Associate Agreement - Updated!(Stock No. 1771)
Authorization to Release Patient Information (Stock No. 1773 or 1773/2)
Request for Amendment of Information (Stock No. 1775)
Denial of Amendment (Stock No. 1776)
Disclosure Log - Updated! (Stock No. 1779)
Confidential Patient Sign-In Log (Stock No. 1791)