Notice of Privacy Practices Acknowledgement

Notice of Privacy Practices Acknowledgement
I have been informed of the Alliance Obstetrics & Gynecology Notice of Privacy Practices. I understand that Alliance Obstetrics & Gynecology has the right to change its Notice of Privacy Practices from time to time and that I may contact Alliance Obstetrics & Gynecology at any time to obtain a current copy of the Notice of Privacy Practices.
Patient Name

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