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![](https://suppliesshops.gumlet.io/images/S-14531.jpg "Blue Confidential Patient Sign-In Label Forms, 8-1/2\")
Blue Confidential Patient Sign-In Label Forms, 8-1/2" x 11", 23 Peel Off Adhesive Sign In Lines (125 Forms per Pack)
Item Number: S-14531
22 reviews
Pricing:
| Price per Pack of 125 | 2+ Packs | 5+ Packs | 10+ Packs | 20+ Packs |
| $61.29 | $56.65 | $54.29 | $53.66 | $52.75 |
| Volume Savings | 7.6% | 11.4% | 12.4% | 13.9% |
| Need 30+ Packs? Click here for Pricing | ||||
- HIPPA Compliant (HIPPA Privacy Rule, Section 164.502)
- Second Sheet is a complete record of all patients seen that day
- Option to call patients by name or number
- Carbonless
- Patient Privacy Sign-In Sheet
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Description:
Keep track of which patients come in to your healthcare facility or medical offices each day with these Blue Confidential Patient Sign-In Label Forms from The Supplies Shops. Each of these 8.5" x 11" HIPAA-compliant confidential patient sign-in sheets comes with 23 peel-off labels. This allows you to ensure that patient information remains confidential since it prevents other visitors from seeing details on the sign-in log. Once completed, you can remove the top portion to reveal the special backer, which will have a complete log of the patient visits for the day.
This form features a simple blue color background with fields for the following patient data: name, arrival time, appointment time, appointment with, new patient check box and a box to indicate a change of address, phone or insurance since the last visit.
- 8.5" x 11" form size
- 23 peel-off labels for confidentiality
- Backer records complete log of patients
- Blue color background
- Carbonless
- HIPAA compliant
- 125 per pack
Specifications:
| ASIN: | B00NBB6UCM | Background Color: | Blue | |
|---|---|---|---|---|
| Brand: | Tabbies | Feature 6: | A special back printing prevents writing from showing on the liner | |
| Feature 7: | Printing on the liner directs patients to sign the next line | Feature 8: | 125 Sheets / Pack | |
| Carbonless: | Yes | Color: | Blue | |
| Condition: | New | Currency: | USD | |
| Pre-Printed: | Yes | Package Height: | 11 in | |
| Package Weight: | 5.00 LB | Package Width: | 8-1/2 in | |
| Material: | Paper | Country of Origin: | USA | |
| Manufacturer Part Number: | 14531 | Number of Items: | 125 | |
| Paper Size: | Letter | Sheet Length: | 11 in | |
| Sheet Size: | 8-1/2 x 11 in | Sheet Width: | 8-1/2 in | |
| Ships in: | 1 to 3 Business Days (Plus time in transit) | Size: | 8-1/2 x 11 in | |
| Text Color: | Black | UPC: | 84371145317 |
| ASIN: | B00NBB6UCM |
|---|---|
| Background Color: | Blue |
| Brand: | Tabbies |
| Feature 6: | A special back printing prevents writing from showing on the liner |
| Feature 7: | Printing on the liner directs patients to sign the next line |
| Feature 8: | 125 Sheets / Pack |
| Carbonless: | Yes |
| Color: | Blue |
| Condition: | New |
| Currency: | USD |
| Pre-Printed: | Yes |
| Package Height: | 11 in |
| Package Weight: | 5.00 LB |
| Package Width: | 8-1/2 in |
| Material: | Paper |
| Country of Origin: | USA |
| Manufacturer Part Number: | 14531 |
| Number of Items: | 125 |
| Paper Size: | Letter |
| Sheet Length: | 11 in |
| Sheet Size: | 8-1/2 x 11 in |
| Sheet Width: | 8-1/2 in |
| Ships in: | 1 to 3 Business Days (Plus time in transit) |
| Size: | 8-1/2 x 11 in |
| Text Color: | Black |
| UPC: | 84371145317 |
Reviews:
4.5
Out of 5.0
Overall Rating
86%
of customers that buy this product give
it a 4 or 5-Star rating.
December 23, 2020 by FIDELIS O
“I am very happy with my purchase and the promptness on delivery.”
December 8, 2020 by Ben S
“There is no space on the form to enter a couple of lines for a confidentiality agreement or some other type of text.”
June 4, 2020 by Sue H (AL, United States)
“All went well”
