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FMLA, HIPAA and Health Insurance Claim Forms

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Employee Medical Records Folder

A2211

Employee Medical Records must be Filed Separately


A number of federal laws, including the Americans with Disabilities Act (ADA), Family and Medical Leave Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA), Genetic Information Nondiscrimination Act (GINA) and Occupational Health and Safety Administration (OSHA), require employers to maintain the confidentiality of employee medical information. These records must be stored in dedicated folders and not in employees’ personnel files. See more details...

as low as $68.95

Fill-and-Save™ HR Form Library: FMLA Administration

A9003W

Manage FMLA Leave with a Complete, Electronic Form System


This collection of essential FMLA forms provides the convenience and benefits of Fill-and-Save™ technology: documents can be sent electronically, and employees/supervisors/managers can complete them by typing directly into fillable fields. Each form is continually monitored and guaranteed to comply with the latest FMLA regulations, and accessible anytime, anywhere, by multiple members of your business. The Library offers the best of both worlds, allowing you to send and store forms electronically for paperless “paperwork,” or print out copies for personnel files. Either way, the most up-to-date FMLA forms and guidance are just a login away. See more details...


Watch this Video to see how easy using the Fill-and-Save HR Form Libraries can be.


Forms require Adobe or Acrobat Reader

Forms will be available 1-12 hours after your order is placed, M - F.
See Product Specifications tab for details.

This product is for an annual subscription and will automatically renew after 1 year.

$99.00

1-Part Pinfeed CMS-1500 Forms

L0289

CMS-1500 Form - 1-Part Pinfeed


1-Part Pinfeed CMS-1500 Forms, version 02/12, are updated with the latest revisions. The forms are 100% compliant and printed to exact specifications for layout, paper, ink and for use with most pinfeed printers.


Forms feature Anti-Rejection Protection™ which is guaranteed acceptance by insurance carriers for rejection proof claim filing.


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $49.95

3-Part Pinfeed CMS-1500 Forms

L0292

These 3-Part Carbonless Pinfeed CMS-1500 Forms (white/yellow/pink) are updated with the latest revisions (version 02/12). The forms are 100% compliant and printed to exact specifications for layout, paper, ink and for use with most pinfeed printers.


Forms feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing.


Forms sold in cartons of 1,000


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $82.95

ComplyRight FMLA Administration System

A1441

Manage FMLA with One Complete System


The ComplyRight™ FMLA Administration System gives you all the FMLA forms, guidelines and information you need to effectively manage FMLA requests according to FMLA regulations. With clear instructions and easy-to-use forms, the system simplifies your FMLA responsibilities.


Interested in a downloadable option?
Try the Fill-and-Save FMLA Administration Form Library.

$167.00

Employee Medical Records Folder Expanded

A3325

Employee Medical Records must be Filed Separately


Confidential Employee Medical Records Folders are perfect for storing required FMLA forms and for documenting accident and illness information as required by OSHA. Plus, the folder simplifies the employee medical records documentation process by using the sections on the front of each folder to record medical conditions and medications, plus medical, dental and life insurance information.

See more details...

$106.00

FMLA Administration System Refill Pack

A1433
Stay Stocked up on Everything you Need to Properly Manage FMLA Requests

Always be ready to properly respond to any FMLA situation with the FMLA Administration System Refill Pack. This helpful bundle gives you replacements for every form in your ComplyRight FMLA Administration System.

$122.00

FMLA Leave Tracker Form

A1436

Easily Track FMLA-Related Employee Time Off


The ComplyRight™ FMLA Leave Tracker helps employers monitor and tally the amount of time an employee uses for FMLA leave.

$50.95

HIPAA Employee Information Poster

A0953

All the HIPAA Compliance Materials you Need to Comply with New HIPAA Regulations


Complies with HIPAA Rules


All businesses covered by HIPAA and any business that offers products or services that interact with protected health information are required to:

  • Notify individuals when their health information has been breached
  • Update their HIPAA policies and procedures
  • Train employees on updated procedures (including what to do if a breach occurs)

$27.95

HIPAA Notice of Privacy Practices

A1420

Explain how Patients' Medical Information may be Used and Disclosed under HIPAA


Complies with HIPAA Rules

According to the Health Insurance Portability and Accountability Act (HIPAA), health care providers and other covered entities are required to give patients a Notice of Privacy Practices. The form provides a plain language description of how protected health information may be used and disclosed, an individual’s rights with respect to the information, a providers’ legal duties with respect to the information and who the individual can contact for more information.

$20.95

HIPAA Notice of Privacy Practices Poster

A2123

Complies with HIPAA Rules


The HIPAA Notice of Privacy Practices Poster is compliant with HIPAA rules, and should be displayed in your waiting room or reception area to inform patients of their rights and responsibilities under HIPAA. The poster provides a plain language description of how protected health information may be used and disclosed, an individual’s rights with respect to the information, a health care providers’ legal duties with respect to the information and who the individual can contact for more information.

$24.95

HIPAA Patient Acknowledgement of Receipt of Privacy Practices

A1354

Satisfy HIPAA Compliance Obligations as a Healthcare Provider


Complies with HIPAA Rules


As a health care provider, you are required by HIPAA to adopt policies and procedures to protect the confidentiality of your patients’ health information. This includes giving patients written notice on how you may use and disclose their protected information and having policies in place to address patient privacy complaints. This attorney-approved form satisfies your HIPAA obligations by documenting compliance.

$35.95

HIPAA Patient Consent & Authorization For Release of PHI

A1350

Satisfy your HIPAA Obligations Regarding the use or Disclosure of Certain Medical Information


Complies with HIPAA Rules


Use our HIPAA Patient Consent and Authorization for Release of PHI to meet your HIPAA obligations. HIPAA requires health care providers and other covered entities to obtain an individual’s written authorization for any use or disclosure of protected health information (PHI) that is not for treatment, payment or health care operations or otherwise permitted or required by the HIPAA Privacy Rule. The form includes all HIPAA required elements that must be included in an authorization to make it valid.

$35.95

HIPAA Protecting Patient Privacy Poster

A2126

Explain New HIPAA Rules to Employees and Patients


The HIPAA Protecting Patient Privacy Poster communicates HIPAA rules to employees and explains their obligations to your patients. The poster is recommended to educate your employees on how and when patients’ medical information may be used and disclosed, and what to do if a breach occurs.

$24.95

Laser CMS-1500 Forms - Pack of 100

L0185

CMS-1500 Laser Forms, version 02/12, are updated with the latest revisions. The form is 100% compliant and printed to exact specifications for layout, paper, ink and designed for use with most laser or inkjet printers. Forms can also be handwritten.


Forms feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing.


Forms sold in packs of 100


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $9.95

Laser CMS-1500 Forms - Pack of 2500

L0293


CMS-1500 Laser Forms, version 02/12, are updated with the latest revisions. The form is 100% compliant - printed to exact specifications for layout, paper, ink and designed for use with most laser or inkjet printers. Forms can also be handwritten.


Forms feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing.


Forms sold in cartons of 2,500


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $49.95

Medical Professional Appreciation Card

G0032E

A personal touch can mean so much, especially now!


Show others that your thoughts are with them with this Medical Professional Appreciation Greeting Card. This card provides you with enough space to include a personal message, so you can remind others that we are all facing this global pandemic together. Envelopes included.


Sentiment: Just a reminder that you're an important member of the team and we appreciate all that you're doing.

as low as $0.81

Separation Notice

A0373

Ensure Accuracy when Employees Leave


Completing the Separation Notice satisfies all the documentation needed when an employee resigns, is laid off or retires. The checklist covers critical issues that must be discussed with an employee upon separation from employment. Completion of this form starts the process for COBRA (Consolidated Omnibus Budget Reconciliation Act) and issuance of final pay.
$50.95

Fill-and-Save™ COVID-19 Vaccination Certification

A0148CFL

Easily Document the Vaccination Status of Your Workforce


Ask employees to certify their current COVID-19 vaccination status without requiring copies of their vaccination cards with the Fill-and-Save™ COVID-19 Vaccination Certification form. The information gathered can be used to establish effective workplace safety protocols as recommended by the Occupational Safety and Health Administration (OSHA). See more details...


Fill-and-Save™ technology allows you to fill out the form electronically (and email to your employees if necessary). Completed forms can be stored electronically as PDFs or printed out for paper recordkeeping.


This product is a downloadable file. A link will be provided via email after checkout.

$27.95

Imprinted CMS-1500 Form - Laser 100 Pack

L0293I

Fully Compliant CMS-1500 Laser Forms


The imprinted CMS-1500 Laser Forms option (version 02/12) is fully updated with the latest form revisions. The form is 100% compliant and printed to exact specifications for layout, paper, ink and designed for use with most laser or inkjet printers. Forms can also be handwritten.


These forms also feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing. See more details...


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $43.95

Imprinted CMS-1500 Forms - Laser 2500 Pack

L0190I

Fully Compliant CMS-1500 Laser Forms


The imprinted CMS-1500 Laser Forms option (version 02/12) is fully updated with the latest form revisions. The form is 100% compliant and printed to exact specifications for layout, paper, ink and designed for use with most laser or inkjet printers. Forms can also be handwritten.


These forms also feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing. See more details...


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

$175.00

Imprinted 2-Part Handwritten CMS-1500 Forms

L0294I

Fully Compliant CMS-1500 Laser Forms


The imprinted CMS-1500 Laser Forms option (version 02/12) is fully updated with the latest form revisions. The form is 100% compliant and printed to exact specifications for layout, paper, ink.


These forms also feature Anti-Rejection Protection™, which is guaranteed acceptance by insurance carriers for rejection proof claim filing. See more details...


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $94.95

CMS-1500 Catalog Envelopes

L0238


CMS-1500 Catalog Envelopes are specifically designed to perfectly fit CMS-1500 Forms. Envelopes are 100% compatible with UCCI requirements.


Envelopes sold in packs of 100


Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $24.95

CMS-1500 Forms and #10 Window Envelopes

L0279

Get both CMS-1500 forms and envelopes in a convenient set for a great price. The CMS-1500 Forms, version 02/12, are updated with the latest revisions and are 100% compliant - printed to exact specifications for layout, paper, ink and for use with most laser printers.


The #10 envelopes are specifically designed to perfectly fit CMS-1500 Forms, are self-seal, 100% compatible with UCCI requirements and tinted inside for confidentiality.


Note: self-seal envelopes are non-refundable



Sets sold in packs of 500, 1,000 or 2,500

Sets also available with catalog envelopes - L0288



Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

$62.95

CMS-1500 Forms and Catalog Envelopes

L0288

Get both CMS-1500 forms and envelopes in a convenient set.


The CMS-1500 Forms (version 02/12) are updated with the latest revisions and are 100% compliant - printed to exact specifications for layout, paper, ink and for use with most laser printers. The catalog envelopes are specifically designed to perfectly fit CMS-1500 Forms, are self-seal for easier sealing and 100% compatible with UCCI requirements.



Sets also available with #10 envelopes - L0279



Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

$212.00

Gummed CMS-1500 #10 Envelopes

L0026


CMS-1500 Envelopes are designed to perfectly fit CMS-1500 Forms. Envelopes are gummed and 100% compatible with UCCI requirements and tinted inside for confidentiality.


Envelopes sold in boxes of 500

Envelopes also available imprinted - L0026I



Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $38.95

Self-Seal CMS-1500 #10 Envelopes

L0237


CMS-1500 Envelopes are specifically designed to perfectly fit CMS-1500 Forms. Envelopes are self-seal for easier sealing, 100% compatible with UCCI requirements and tinted inside for confidentiality of components.

Note: self-seal envelopes are non-refundable



Envelopes sold in boxes of 500

Envelopes also available imprinted - L0237I



Shipping times for this product may be delayed.
We appreciate your understanding as we work to fill orders as quickly as possible.

as low as $44.95

Double Window Statement or Billing Envelopes

L0017


Double Window Statement and Billing Envelopes are compatible with laser, continuous and pegboard checks and forms. Envelopes are self-seal and tinted inside for confidentiality of inside components.


Envelopes sold in boxes of 250


Note: self-seal envelopes are non-refundable

as low as $81.95

UB04 Laser Forms - Pack of 100

L0188

UB04 Laser Forms are updated with the latest revisions. The form is 100% compliant with UCCI requirements and designed for use with most laser or inkjet printers.


Forms sold in packs of 100

as low as $6.95

UB04 Laser Forms - Pack of 2500

L0248

UB04 Laser Forms are updated with the latest revisions. The form is 100% compliant with UCCI requirements and designed for use with most laser or inkjet printers.


Forms sold in cartons of 2,500

as low as $2.75

UB04 Forms - Catalog Envelopes

L0161


UB04 Catalog Envelopes are specifically designed to perfectly fit UB04 Forms. Envelopes are 100% compatible with UCCI requirements.


Envelopes sold in packs of 100

as low as $25.95

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