Protected Health Info Disclosure Log
VW-129277
797 0011
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Protected Health Info Disclosure Log. As required by HIPAA, you must track to whom disclosures of PHI are made. This form, retained in each patient's medical record, includes the pertinent information that should be recorded when disclosures are made. This form will be photocopied for patients who request an "Accounting of Disclosures". Pkg/250