651 Medical Record Disclosures Log

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Whatyour

651
(On
Medical
Client:
PHI___________________________________
record
letterhead)
was
disclosed?*
disclosure
Form for alog
medical
To record
whom? disclosure
File log
number
For ___________________
what purpose?
When?
By whom?
*This
Codes:
is page
F = Financial,
___ of ___ Billing,
pages. Collections, Payments. PN = Routine Progress No
tes. PTN = Psychotherapy Notes. WR = Whole Record.

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