HIPAA Manual

 

The IPMA will have the HIPAA Manual available to those members who cannot download one from the internet for a fee of $15.00, $100 for non-members.  This fee covers the postage and printing costs of the manual.  Please call the IPMA office at 312/427-5810 for further information.

 

Name (PRINT):  _______________________________________________________________

 

Address:  _____________________________________________________________________

 

City:  ______________________________  State:  ________  Zip Code:  __________________

 

Telephone number:  _____________________________________________________________

 

____ manual (s) x $15.00 each =  $____________

 

Payment Method (check one):          Check enclosed in the amount of  $ _______

 

                                    0 Visa      0 M/C      0 Discover        

 

Card Number: ______________________________________________________________

 

Expiration: ______________________    Amount: _________________________________

 

Cardholder’s Name:______________________________________________________________

 

Cardholder’s Signature:___________________________________________________________

 

Mail your form to: IPMA HIPAA Manual, 122 S. Michigan Ave., Suite 1441, Chicago, IL 60603.  If paying by credit card, you may fax your form to 312/427-5813.  There is a $25 charge for returned checks/refused credit cards.