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PROTECTED HEALTH INFORMATION DISCLOSURE LOGS (250/CASE)


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Item Number: W-HIP104
AS REQUIRED BY HIPAA, YOU MUST TRACK TO WHOM DISCLOSURES OF PHI ARE MADE. THIS FORM, RETAINED IN EACH PATIENT'S MEDICAL RECORD, INCLUDES THE PERTINENT INFORMATION THAT SHOULD BE RECORDED WHEN DISCLOSURES ARE MADE. THIS FORM WILL BE PHOTOCOPIED FOR PATIENTS WHO REQUEST AN "ACCOUNTING OF DISCLOSURE".
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