Used to obtain patient and/or legal guardian consent for hospice care and to provide supportive evidence that contain required admission elements were reviewed prior to admission to hospice. And to demonstrate receipt of HIPAA notice of privacy practices.
Briggs
Healthcare does not allow use of any of its intellectual property without a
valid license and payment of fees. This
prohibition includes the copying and reproduction of forms, in whole or in
part, in any format, including paper and electronic.
Size: 8.5 X 11 Paper: 2-part - white and canary Print: Black Ink Punching: 5-holes top and side Packaging: 100 per pack
