HIPAA Notice

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HIPAA NOTICE

The Privacy Rule portion of the Health Insurance Portability and Accountability Act of 1996 requires our practice to submit a copy of the Privacy Notice to each patient, both existing and new. If you would like a copy of our Notice of Privacy Practices please let our front desk know, there are copies available.
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Name
First Name
Last Name
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Date
Date
Year
Month
Day
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Signature
Clear
Should be Empty:

HIPAA NOTICE