Make it easy for patients to review and acknowledge your HIPAA Notice of Privacy Practices using this secure, digital HIPAA Acknowledgment Form App Block. Ideal for clinics, hospitals, and telehealth providers, this form replaces paper-based acknowledgments with a streamlined, mobile-friendly solution. After reviewing the notice, patients simply enter their name, date, and signature, then submit the form. A confirmation message is displayed, and if configured, a notification email is sent to designated compliance or administrative personnel for record-keeping. Built on Caspio Flex, this App Block is fully customizable. You can adjust layout, and branding, or add fields like patient ID or contact information. It can be embedded in portals, emailed as a direct link, or included in check-in workflows. This form is intended for Caspio HIPAA compliant plans. Need help configuring any part of it? We're here to assist..

Features

• Mobile-friendly HIPAA acknowledgment form for patient use.
• Captures name, date, and optional digital signature for compliance.
• Optional email notification sent to designated compliance or admin team.
• Add or remove fields to match your organization’s compliance needs.
• Embed in patient portals, websites, or include in digital intake workflows.
• Supports healthcare documentation and privacy practice compliance.
• Helps streamline HIPAA acknowledgment and reduces paper handling.