Item# HACK1 'Acknowledgement of Receipt' form

Ancom has designed and printed over 1,000 custom professional forms for our customers, including the Healthcare industry, whose offices have relied on our stock professional forms for years. At Ancom, you’ll find the ready-made forms that you need: HIPAA forms, HCFA forms, ADA forms, and Rx pads, along with X-Ray mailers, recall postcards, laser statements and mailing envelopes. To get started on designing your own custom professional form, see our Custom Forms section.

Item# HACK1  ‘Acknowledgement of Receipt’ form

Item# HACK1

'Acknowledgement of Receipt' form

Acknowledgement of Receipt is signed by patients who have received notification of your practice's privacy policies (see Notice of Privacy Practices). Personalized with your practice name.

•Hole-punched for easy insertion into patient chart.

•8.5" x 11"

•Black print on white paper.