Spanish HIPAA Documents
HIPAA Documents Translated to Spanish
In order to help the durable medical equipment supply industry (DME) excel in a bilingual market, Foreign Translations, Inc. is working hard to eliminate the language barrier between the supplier and the Medicare beneficiary. We have identified five essential documents that facilitate the establishment and continuance of a relationship with a Spanish-speaking customer. These will enable the DME supplier to comply with Medicare standards while providing the Spanish-speaking beneficiary with the assurance that they are in good hands when choosing a supplier.
Spanish Forms Kit for DMEPOS Suppliers
This kit provides DMEPOS providers with the Spanish versions of five documents essential for compliance with Medicare and HIPAA standrds, and to establish an account for a Spanish-speaking customer. The kit is comprised of the Assignment of Benefits form, CMS Supplier Standards, Notice of Privacy Practices, Patient Bill of Rights and Responsibilities, and an Application to Receive Medical Supplies. The documents can be downloaded individually or as a kit. The translations provided are certified.
$249.95 Full Kit
Includes all 5 Documents - Save 67%
Assignment of Benefits Form (Spanish)
The Assignment of Benefits (AOB) extends the contractual relationship held between the patient and his/her insurance provider to the DME supplier and the patient’s insurance provider. The patient’s signature on the AOB permits the DME supplier to bill the patient’s insurance directly for supplies provided to the patient. The translations provided are certified.
Assignment of Benefits Form (Spanish) - $75.00
Application to Receive Medical Supplies (Spanish)
The customer application can be completed in person, over the telephone, or via fax. This document is designed for the collection of important information, such as Patient Name, Address, Social Security Number, Alternate Shipping Information, Emergency Contact Information, Primary and Secondary Insurance Company Information, and Policy ID’s. Space is provided to indicate specific products requested by the patient and patient referral information. The translations provided are certified.
Application to Receive Medical Supplies (Spanish) - $75.00
CMS Supplier Standards (Spanish)
All Medicare DMEPOS suppliers must be in compliance with these Supplier Standards in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R.pt. 424, sec. 424.57. Medicare requires the DME supplier to inform the patient of these standards. The translations provided are certified.
CMS Supplier Standards (Spanish) - $75.00
Notice of Privacy Practices (Spanish)
DME suppliers are required by the Health Insurance Portability and Accountability Act of 1996 to maintain the privacy of each patient’s Protected Health Information (PHI). The Notice of Privacy Practices informs the patient of the ways in which his or her PHI may be used and disclosed by the supplier. The notice describes the patient’s rights and the supplier’s responsibilities regarding the use and disclosure of PHI. The translations provided are certified.
Notice of Privacy Practices (Spanish) - $75.00
Patient Bill of Rights and Responsibilities (Spanish)
The Patient Bill of Rights and Responsibilities promotes patient confidence in the U.S. healthcare system, emphasizes the benefits of a good patient-provider relationship, and informs patients of their active role in their treatment plan. DME suppliers must inform patients of their right to easily understood information, choice of providers and plans, access to emergency services, participating in their treatment plan, respectful treatment without discrimination, privacy of protected health information, etc. The translations provided are certified.