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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):
Any nurse that accepted the Portal Users Agreement
needs a manual.
Cost includes shipping.
Security
and Privacy Manual ($70 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
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