HIPAA Forms

Patient information is automatically merged into these and most other forms. This reduces double entry and adds a high degree of professionalism. HearForm contains the following HIPAA template Forms:

• Acknowledgment of Disclosures
• Accounting Disclosures Log
• Authorization Disclosure (2)
• Business Associates Agreement
• Consent for Treatment
• Patient Compliant
• Privacy Practices Notice
• Receipt of Notice (2)
• Request to Inspect and Copy
• Request for Correction
• Facesheet

To change (edit) a desired form, click to GoTo button. Enter Browse Mode and use the text tool to modify any text. (You must open HearForm with appropriate privileges in order to edit forms and letters in layout mode.)

• Sample of the Accounting of Disclosures Form
• Sample of the Accounting of Disclosures Log Form
• Sample of the Authorization Disclosure 1 Form
• Sample of the Authorization Disclosure 2 Form
• Sample of the Business Associates Agreement
• Sample of the Consent for Treatment Form
• Sample of the Patient Complaint Form
• Sample of the Privacy Practices Notice
• Sample of the Receipt of Notice 1 Form
• Sample of the Receipt of Notice 2 Form
• Sample of the Request to Inspect and Copy Form
• Sample of the Request for Correction Form
• Sample of the HIPAA and Face Sheet Form

* Note: HearForm offers these forms simply as a guide. It is the responsibility of each individual practice to modify HIPAA forms so that they are within compliance of current laws. HearForm takes no responsibility for the content of these forms, but again simply provides them as a template and a starting point. HearForm maintains no liability for the content of any forms contained within our software.