Patient Confidentiality Sign-In Sheet
with Record Copy

PATIENT CONFIDENTIALITY
SIGN-IN SHEETS - PSL20
Shingled Set Version

Twenty (20) shingled tickets printed on bond sheets are glued to a two-part carbonless set. Tickets are consecutively numbered on the body of the ticket and on a stub that is given to the patient. This allows the office staff to call the patient by either name or by number. Nothing transfers to the first part of the set, but does transfer to the second part - which is not visible to the patient. Information becomes a permanent record of patients who have visited the office that day.

Each set includes 20 sign-in tickets.

Shingled Tickets, numbered in two positions, record the patient's registration information. The ticket is filled out by the patient and detached from the booklet. The patient retains the numbered stub and gives the ticket to the receptionist. This allows the health care provider the option of calling in patients by their name OR by their number on the stub receipt.

As the registration progresses, as patients sign in, they cannot view the names above theirs due to the block out of information on page one of the two part log sheets. The second journal page records each line entry of registration. The two journal sheets are spot glued on both sides to prohibit viewing of the logged information.

This is a SECURE Document

Unlike other forms, special security features built into the Micro Format Patient Confidentiality Sign-In Log give both the health care professionals and the patient privacy while transacting the medical information process during office visits.

PATIENT CONFIDENTIALITY
SIGN-IN SHEETS - CSL-20
Label Version

The label version is a two-part set with part one being label material. The second part is a bond sheet with a sheet of carbon paper in between. There are slits below each line that allow office staff to remove each entry as the patient signs in. The strip is then attached either to the patient's chart or to the sheet outlining the reason for the patient's visit. All of the information transfers to the second part of the form and becomes a permanent record of patients who have visited that day.

Each set contains 20 numbered strips.

Label strips, numbered in two positions. record the patient's registration information. The strip is filled out by the patient and removed from the top page. The patient retains the small numbered stub and gives the long strip to the receptionist. This allows the health care provider the option of calling in patients by their name OR by their number on the stub receipt.

As the registration progresses, as patients sign in, they cannot view the names above theirs since the entire registration label has been removed from the top page. The second journal page records each line entry of registration. The label sheet and the journal sheet is glued on both sides to prohibit viewing of the logged information.

This is a SECURE Document

The Special security features are built into the Micro Format Confidential Sign-In Log give both the health care professionals and the patient privacy while transacting the medical information process during office visits.

Item# CSL20 Each "Sign-In Log" includes 20 sign-in label strips	CSL20 200 sets ~ $165.00
	CSL20 500 sets ~ $350.00
	CSL20 1000 sets ~ $500.00