In the ADA HIPAA Kit, the form is called “Acknowledgement of Receipt of Notice of Privacy Practices.” The HIPAA Privacy Rule requires covered health care providers to make “good faith efforts” to obtain written verification that patients have received the dental practice’s Notice of Privacy Practices. Covered entities should have each patient sign an acknowledgement form when he or she receives a copy of the Notice of Privacy Practices. The signed acknowledgment forms can help a dental practice demonstrate that it is in compliance with this HIPAA requirement.
