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Acknowledgement of Notice of Privacy Practice HIPAA Mobile App

The Acknowledgement of Notice of Privacy Practice HIPAA mobile app makes it easy for physicians to collect a signed acknowledgement from patients confirming that they have been presented with the Notice if Privacy Practices required by HIPAA. This app captures a signature. Signatures captured with using your finger are completely acceptable.

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  • Mirvac

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Take a peek inside the Acknowledgement of Notice of Privacy Practice HIPAA Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    I have been presented with a copy of the Notice of Privacy Practices for the office of

  • Ico statictext

    detailing how my information may be used and disclosed as permitted under federal and state law.

  • Ico signature

    Signed:

  • Ico date

    Date:

  • Ico statictext

    If not signed by patient, please indicate relationship to patient (e.

  • Ico signature

    Patient:

  • Ico textbox

    Relationship:

  • ...and More!

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