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In order to be listed within hipaaspecialists.com you must meet the minimum requirements:

• Be PMRNC subscriber    SUBSCRIBE NOW
• Completed any HIPAA Course/Exam with regards to HIPAA
• Provide source for us to confirm your HIPAA Course completion
• If you are a company or contractor that is located offshore or offers offshore outsourcing, please do NOT complete this form as we will not list any company or individual located or doing any business offshore...NO EXCEPTIONS. If you utilize offshore contractors or are located offshore we will not consider your listing and we will not be contacting you.

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Reminder, if you are not a current PMRNC Subscriber, please don't complete this form unless you  SUBSCRIBE NOW or visit us at www.billerswebsite.com to learn more about us.

Your Full Name
PMRNC Username
Company Name
Company Address
City
State
Zip Code
Work Phone
Email
Website URL
Is your listing...	NewUpdate
HIPAA Course Completion Date
Company with which you completed your course with
Contact person, Phone and/or email to confirm
Is your billing company HIPAA Compliant now?	YesNO
If not, please explain:
Are you current with continued HIPAA Awareness and education	YesNO
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