Acknowledgement of HIPAA NPP

Completion of this document authorizes the disclosure and use of health information about you. Failure to provide all information requested may invalidate this authorization.

PocketRN is committed to protecting your privacy and ensuring that your health information is used and disclosed appropriately. The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires us to ask each of our patients to acknowledge receipt of our Notice of HIPAA Privacy Practices. This Notice of Privacy Practices identifies all potential uses and disclosures of your health information by our practice and outlines your rights with regard to your health information. Please sign the form below to acknowledge that you have received our Notice of Privacy Practices.

The Notice is published on the PocketRN website. You can also receive a copy of the Notice by asking for one from PocketRN Support, or by printing one from our website, PocketRN.com, at any time. On our website you can find links to our Privacy Policy, HIPPA NPP, and Terms on the bottom toolbar, or you can use the links listed below.

Privacy Policy

HIPAA Notice of Privacy Practices

Terms of Service

By signing this document, I acknowledge that I have received a copy of the Notice of Privacy Practices of PocketRN.