HIPAA of 1996
mandates data
privacy and security
for safeguarding
patient’s medical
information.
Free Download 
HIPAA of 1996
mandates data
privacy and security
for safeguarding
patient’s medical
information.
Learn More About HIPAA Compliance Regulations
HIPAA requires Healthcare facilities to safeguard and maintain
confidentiality of all electronic protected health information.
Mantain complete confidentiality,
integrity, and availability of all
electronic protected health
information that is created,
received or transmitted.
Identify and protect
against reasonably
anticipated threats to the
patients information &
security.
Ensure proper training and complete
compliance by your
workforce.
mConsent provides 100% HIPAA Compliant
Online Dental Intake Forms.
General HIPAA Privacy Breaches in Dental Offices
Not properly maintaining
confidentiality of patient data
via encryption.
Failing to attain patient
authorization prior to release
of personal information.
Improper discarding of patient
data via paper forms.
Want to Ensure HIPAA Compliance at your Office?
Streamline your Practice with Digital HIPAA Compliant Forms
Patients Can Complete
Forms Remotely
Integrates with Major
EMR Software
Personalize your Own
Patient Forms
Scan ID, Insurance
Card & More
Patient Data Stored in
the Cloud System
Customized iPad
for In-Office Use
FAQs on HIPAA Forms
A HIPAA form is a document that protects your medical information. It enables healthcare providers to share your health information only with those you permit.
Entities that must abide by HIPAA include health care providers, health plans, and health care clearinghouses.
HIPAA standards prohibit sharing medical information without permission, accessing data without authorization, discussing patients in public, and leaving sensitive documents where others can see them.
By scrolling to the top of the page and clicking on 'Free Download,' you'll be able to download our HIPAA form.
A Dental HIPAA form is necessary to protect your privacy. It ensures that your dental information remains secret and can only be shared with your permission.
A dental HIPAA form typically includes personal information like name, address, and insurance details. It also covers consent for treatment and acknowledges an understanding of privacy policies. Additionally, it may include medical history, medications, and emergency contacts. All this ensures patient confidentiality and compliance with HIPAA regulations.
Ensure Accurate & Complete Patient Info Provided
- Patient’s Full Name
- Patient’s DOB
- Other Source of Identification as Needed
Disclosure to Which Entity, Office or Party
- Another Dental Office
- Self
- Other (Indicate)
Method of Delivery
- Fax
- Postal Mail
- Pickup
What Information is Being Disclosed
Indicate the type of information
- Treatment Plans
- Radiology X-Rays & Images
- Billing Records
- Other Info
Option for Specific Instructions
- Allow option for Patient to Indicate What should not be Disclosed
Expiration Date of Disclosure
- Clear Indication of dates that Disclosure of information is permitted
- Ensure that the applicable dates are followed by your office
- If patient information is shared with a third party outside of the expiration date, you could face legal consequences
Signed Acknowledgement
- Patient or legal Guardian must sign the form
- Bypassing a patient’s signature can have legal ramifications
- Never Disclose patient’s information without their signed consent
- If patient is under the age of 18 be sure to have a legal guardian sign on their behalf
Success Stories
Grace
"Before mConcent everything was definitely more labor intensive, lots of time consuming paperwork that we don't have to do now with mConcent."
ADIRA "DEE" BAILEY
"Before using mConsent I had to print out the router sheet everyday and get the patient's signature, very time consuming."
Stefanie Daley
"Before using mConsent we had to find and pull patients' charts and input data, it takes a lot of time."
