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HIPAA - Patient Disclosure Form - DS100-2

In Store Price: $42.85
Your Online Price: $35.25
You Save Online: $7.60 (18 %)
Protect your practice and avoid privacy disputes with this clear, step-by-step form authorizing release of patient information.
  • Includes your imprinted practice name, address, and phone number, up to 5 lines.
  • 2-part form provides a patient copy and a 2-hole punched permanent record.
  • 8 1/2" x 11"
  • 250 Per Pack
  • Larger Quantities and Discounts Available
Item Number: 04-DS100-2

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