Notice of Privacy Practices Acknowledgement Form

Form Template

Get closer to going paperless in your health care practice with an easy mobile app for patients to sign and date your privacy practices acknowledgement form.

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This digital form, to acknowledge compliance with HIPAA and HIPAA privacy practices, can be customized by any health insurance or healthcare provider and used by patients directly on a smartphone, tablet or PC. Easy check mark boxes and fillable forms to sign and date will help to streamline patient check-in at hospitals, family medicine practices, dental offices or any health care provider.

Get your patient's acknowledgement of your privacy practices, acts that their doctor may potentially be performing in the future and their understanding that their health information has been taken into account and will be opted by the health care provider if it will be disclosed to other physicians.

Save your digital privacy practice acknowledgement forms to the GoCanvas Cloud as well as a PDF file for your record-keeping ease.

  • Signature Capture
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  • iPhone
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  • Quickbooks
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