Notice of Privacy Practices Form Template

Every patient needs to be notified, understand, and acknowledge their rights under the HIPAA Privacy Rule. Now they can easily receive the notice, read, and sign prior to their visit – on their own time, via a phone, tablet or computer.
Notice-of-Privacy-Practices

Notice of Privacy Practices Form Template

Give your patients the freedom to complete notice of privacy practices forms with any device, anywhere. Streamline the way you collect signatures by setting up your form online.

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What is the Notice of Privacy Practices Form?

The notice of privacy practices informs patients of their healthcare privacy rights under the HIPAA Privacy Rule.  It is important that all patients be given this information and be assured that their healthcare provider protects their health information. The privacy notice is customizable for many languages to ensure all patients are accommodated.  

The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices.

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Autocomplete HIPAA Compliant Forms

Autocomplete Forms

Have your patient enter information once and have it autocomplete throughout your medical form online. Automatically populate PHI directly into additional fields and medical consent forms.

Appointment Reminder

Patient Appointment Reminder

Schedule automatic reminders to your patients to complete your forms before their appointment. Get more completed forms online before the scheduled appointment.

HIPAA Compliant Forms Dedicated Server

Dedicated Servers

Host your HIPAA compliant online forms and PHI on a dedicated server with a FormDr White Label Enterprise account. Keep your patient’s data secure while collecting form submissions with any device, anywhere, at any time.

HIPAA Compliant Electronic Signatures

HIPAA Compliant Electronic Signatures

Collect electronic patient signatures before the appointment. Easily give your patients the ability to digitally sign from their phone, tablet, or computer.

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
  • Are emailing patients a PDF or Word Doc to print out, fill out, scan, and send back
  • Are spending time manually printing and scanning paper forms