Request for Accounting of Disclosures of Protected Health Information

 Request for Accounting of Disclosures of Protected Health Information
The Forms Professionals Trust! ™
State:
Multi-State
Control #:
US-3581
Instant Download
$19.95
$16.96
Mail Paper Copy
$25.95
$22.06
Adding a Completed Sample is Available in your Cart
Available formats: Word | Rich Text

Free Preview

Description

This form is used by an individual to request an accounting of the persons or entities to whom the individual's protected health information has been disclosed. Permitted exclusions from the accounting are also described.

All forms provided by U.S. Legal Forms, Inc.™, (USLF), the nations leading legal forms publisher. When you need a legal form, don't accept anything less than the USlegal™ brand. "The Forms Professionals Trust ™


Gold Award 2006-2018

BEST Legal Forms Company

11 Year Winner in all Categories:
Forms, Features, Customer Service
and Ease of Use.



100% Satisfaction Guarantee

"I ordered some Real Estate forms online and as a result of my error, I placed the order twice. This morning I called Customer Service and Vern immediately credited back my Visa the extra amount. No problems, no lectures, no hassle."

U.S. Legal Forms, Inc. BBB Business Review