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WHIP106 Patient Request For Accounting Of Disclosures
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| P R O D U C T D E T A I L S |
| Product Info: | Health Portability and Accounting Act (HIPAA) form that meets the Protected Health Information (PHI) requirements.
The patient that request an "Accounting of Disclosures" will be asked to complete this form that requires the patient to provide the purpose of the request, the dates requested, etc.
The form, retained in the patient's medical record, also allows you to record the date you comply with the request. |
| P R O D U C T P R I C I N G |
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Parts |
| Quantity |
1 |
| 100 | 20.00 | | 200 | 39.00 | | 300 | 63.00 | | 400 | 69.00 | | 500 | 87.00 | | 600 | 103.00 | | 700 | 121.00 | | 800 | 120.00 | | 900 | 135.00 | | 1000 | 149.00 | | 1100 | 165.00 | | 1200 | 166.00 | | 1300 | 180.00 | | 1400 | 193.00 | | 1500 | 205.00 |
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