Get Hptc Pr-35 2002-2025

This guide provides clear, step-by-step instructions for completing the HPTC PR-35 form online. By following these instructions, you can ensure that your health information is handled appropriately while maintaining your privacy rights.

Follow the steps to complete the HPTC PR-35 form.

1. Click the ‘Get Form’ button to access the HPTC PR-35 online document and open it in the editor.
2. In the first section, review the information regarding your rights to privacy under the Health Insurance Portability and Accountability Act (HIPAA). Ensure you understand the purposes for which your protected health information may be used or disclosed.
3. Fill in the date in the specified format (day, month, year) on the line indicated.
4. Print your full name in the designated space for 'Print Patient Name'. Make sure it matches your official identification.
5. Sign your name in the provided area labeled 'Signature'. Ensure that your signature is clear and legible.
6. Indicate your relationship to the patient in the section provided. Use terms that reflect your role, such as 'partner', 'parent', or 'guardian'.
7. Complete the practice information, including the practice name (Staples Dental Care), address, and city/state/zip code as provided in the form.
8. After filling out the form, review all entries for accuracy and completeness. Revisit any sections as necessary.
9. Finally, choose to save your changes, download a copy, print the filled-out form, or share it as needed.

Complete your documents online to ensure proper handling of your health information.