Using sign-in sheets in waiting rooms "may continue, if reasonable safeguards are taken to minimize the chance of incidental disclosure to others." -From "Standards for Privacy of Individually Identifiable Health Information" (Final HIPAA Privacy Rule, Section 164.502) U.S. Department of Health and Human Services August 14, 2002

How to Use This Form

Protect Your Patient’s Confidentiality

Now you can confidentially sign in your patients! Each patient completes the next available line and removes the number to the left of the name. They can then wait to be called by either name or number. Our Patient Sign-In form features a number that has no sticky adhesive (once folded under) for the patient to handle.

Next, the receptionist will remove the adhesive strip and apply it to either the patient’s chart or the call sheet. This will expose the words "Do Not Sign Here" to the next patient.

In many cases, this step is an improvement to the process previously followed. Instead of having to rewrite the information onto the patient’s chart, the receptionist simply applies the adhesive strip to the chart. This saves time and reduces errors.

Part #2 of this form works as a daily log sheet for the office to keep track of their appointments. The 2nd sheet can also help track the wait times of patients.

Our label liner with blockout allows the log sheet to stay protected by not allowing patients to see through the liner. The side stubs also help to prevent any one from peeking!