HTML Code

<form method="post" action="https://www.flufo.com/Greg Miller/2273/hipaa-testing">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">HIPAA Testing </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>Patients are allowed to ask for changes be made to their medical record</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17792]" value="A" /> True</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17792]" value="B" /> False</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>Patients can request to receive a copy of their medical record.</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17793]" value="A" /> True</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17793]" value="B" /> False</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>Every employee of a covered entity must be trained on HIPAA Privacy mandates.</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17794]" value="A" /> True</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17794]" value="B" /> False</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>All covered entity employee training must be documented.</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17795]" value="A" /> True</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[17795]" value="B" /> False</label>
      <br />     
      <div><label for="userName">Your name</label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
      <input type="text" name="userName" id="userName" value="" style="width: 300px;" />     
    </div><br />
    <div>
      <label for="userEmail">E-mail address</label>
      <input type="text" name="userEmail" id="userEmail" value="" style="width: 300px;" />     
    </div><br />
    	<input type="submit" name="submit" value="Ready" /> <span style="margin-left: 200px;">powered by: <a href="http://www.flufo.com" target="_blank">flufo.com</a></span>
  </div>
</form>

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