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Urgent Care HIPAA Privacy Notice Acknowledgement Mobile App

Working in health care, there are many terms and conditions to be familiarized with, especially when it comes to notice of privacy. In order to ensure that patients understand privacy rules, patients at urgent care centers are required to read HIPAA privacy rules. Arguably the most important aspect of the HIPAA privacy rules are the patient privacy rights which state that the information shared with the health care provider will not be disclosed with other people unless the patient authorizes it.

Have your urgent care patients read and acknowledge a HIPAA Privacy Notice using the Urgent Care HIPAA Privacy Notice Acknowledgement mobile app on a tablet or a smartphone. This app allows you to capture the patient’s signature, and the app can also be made HIPAA Compliant. Check out other Urgent Care Apps in our App store for more.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Urgent Care HIPAA Privacy Notice Acknowledgement Mobile App

Included Features

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Included Fields

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

  • Ico statictext

    I acknowledge that I have received the Privacy Notice.

  • Ico textbox

    Patient Name

  • Ico signature

    Patient or Personal Representative Signature

  • Ico date


  • Ico textbox

    If Personal Representative’s signature appears above, please describe Personal Representative’s r...

  • Ico textbox

    If not signed, reason why acknowledgement was not obtained:

  • Ico signature

    Staff Witness seeking acknowledgement

  • Ico date


  • ...and More!

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