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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 ($35.00 Members, $100.00 Non-members)_________
Make check payable to PHP and
mail Order Form and check to:
Fran Meyer
8256 N.
52nd St.
Brown
Deer, WI 53223
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