Accepted starting October 1, 2006
Mandatory by July 1, 2007

HCFA|CMS 1500 Small Envelopes

HCFA|CMS 1500 Large Envelopes

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Accepted until June 2, 2007
Available in Barcode & Non-Barcode

HCFA|CMS 1500 Small Envelopes

HCFA|CMS 1500 Large Envelopes

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Effective March 1, 2007
Mandatory May 23, 2007

Patient Statement Envelopes with Preinserted Return

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Self-seal, imprinted return address
No more licking or addressing your insurance envelopes! The new small HCFA|CMS 1500 envelope is self-seal with your pre-printed return address.

Large self-seal, holds up to 50 claims
No imprinting
Large HCFA|CMS 1500 envelopes are self-seal and hold up to 50 claims! Return address not imprinted.

Self-seal, imprinted return address with imprinted return envelope
Patient statement envelopes are self-seal with imprinted return address.

With one simple system, you're making one HIPAA privacy worry disapper.

Meet the privacy and confidentiality requirements of HIPAA with these two-part carbonless sign-in sheets. It allows patients to sign in without seeing the information of other patients. After patients sign in, labels peel off top of form, showing no protected information!

Get HIPAA compliant (164.520) faster and easier. Save time for your staff and your patient. The HIP120 form is all inclusive. Instead of your patient entering the office and stressfully signing several forms, only one signature is required on the HIP120. That one signature will eliminate the need for The Consent Form, the Acknowledgement Form and the Notice of Privacy Form.

• The HIP120 form includes a peel-off label that obtains acknowledgement from each patient.
• It is applied to the patient's medical chart, which gives the health care provider a systematic method of verifying which patients have ready and received HIPAA requirements.
• HIP120 Form is a cost effective way to comply with HIPAA. Less forms, less office staff time, less patient time.
• HIP120 form is the most comprehensive compliance form in the industry. HIP120 includes in detail numerous purposes where the health care provider discloses information. This will eliminate the need of getting patient authorization in the future.
• Ensure that your practice has done "due diligence" - 164.520.

HIPAA Patient Sign-in Sheets

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