PHI Authorization for HIPAA-compliant Storage and E-Signatures

STEP 1 - START HERE

Start here! Complete this form first to provide your personal information, contact details, emergency contacts, and insurance information.

Authorizations & Acknowledgements

Complete all forms below

Authorize storage of Protected Health Information on HIPAA-compliant Google Workspace and use of electronic signatures.

Acknowledge receipt of our Notice of Privacy Practices (NPP).

Acknowledge understanding of your rights as a client of Silver Home Care.

Direct Care Worker employment status verification and information.

Required regulatory documentation and compliance acknowledgements.

File a complaint or grievance and acknowledge our complaint procedure.