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Notice of Privacy Practices (Form #120)
(includes acknowledgement)

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Written Notice of Privacy Practices must be provided to patients on or before the first encounter and to other persons upon request. The Notice notifies the patient of all uses and disclosures of his or her protected health information. In addition, this form has a removable label that provides practices with a written acknowledgement that the patient received the Privacy Notice, as required to be HIPAA compliant.

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Notice of Privacy Practices (Form #120) (includes acknowledgement)

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