HIPAA - Acknowledgement of Receipt of Notice of Privacy Practice

LCOHPA- ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

  • ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

    We are legally required to provide you with a copy of our NOTICE OF PRIVACY PRACTICES the first time you receive care at UC Health. If you are here for emergency medical treatment, you will be given a copy as soon as possible.

    Patient or Patient’s Legal Representative:

    Check appropriate box and sign.

    Patient or Patient's Legal Representative has:

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