Midwife HIPAA Acknowledgement

Form Template

Please have your patients use the Midwife HIPAA Acknowledgement mobile app and read about their rights under the Health Insurance Portability and Accountability Act (HIPAA) and affirm the following authorizations for disclosure of protected health information (PHI).

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Your midwife center may use or disclose PHI to carry out treatment, payment, or healthcare operations related to care. Examples would be: medical consultations, referrals, or transfer of care, lab or ultrasound orders, and insurance claims on your behalf. GoCanvas apps can all be made HIPAA compliant.

<a href="http://www.gocanvas.com/mobile-forms-apps/search?utf8=%E2%9C%93&terms=Midwife+PDR+Worksheet&categorysearchselect=

">GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

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