For the front desk of a medical, dental, chiropractic or therapy office: name, arrival time, appointment time and provider, and nothing about why they came.
Step 1 · The sheet
Step 2 · Columns
Step 3 · Look
22 rows per page
US Letter, half-inch margins. Print at Actual size (100%).
Nothing you type leaves this device. The PDF is made in your browser.
The U.S. Department of Health and Human Services says offices may use patient sign-in sheets as long as the information on them is appropriately limited (HHS HIPAA FAQ 199). The common reading, which this sheet follows, is: name, arrival time, appointment time and provider, but not the reason for the visit or any other medical detail. The note printed at the top tells patients the same.
This page is general information, not legal advice; your compliance officer has the last word for your office.
Each one opens the maker with its own columns. All of them can be changed.
Yes. HHS says covered providers may use sign-in sheets as long as the information disclosed is appropriately limited, for example leaving off the reason for the visit.
The reason for the visit, symptoms, diagnosis, insurance numbers or dates of birth. Keep it to the name, times and provider.