This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: Request to Inspect/Copy, Request for Restrictions, Request for Confidential Communication, Request for Amendment, and Request for Accounting of Disclosures. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.
8.5" x 11", 1 Part with black ink- Blue "Void" security background. 5 hole punch left and 2 top for insertion in charts. Packaged in 100'S