HIPAA MANUALS FOR INDEPENDENT NURSES

ORDER FORM

Name:_______________________________________________

Address:_____________________________________________

City: _________________________ State:__________________

Zip: _______________  Phone:_(_____)____________________

Member of PHP:__________ yes         ____________ no

I would like to order (please check):

Security Manual ($35.00 Members, $100.00 Non-members)_________

Privacy Manual  ($40.00 Members, $100.00 Non-members)_________

Make check payable to PHP and mail Order Form and check to:

Jenny Rutter

3210 N 79th St

Milwaukee, WI  53222