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Wilmington Health
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
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01
Begin by providing your personal information in the designated fields. This includes your full name, address, contact number, and email.
02
Next, specify the date on which the notice form is being filled out.
03
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04
Clearly state the purpose of the notice in the designated section. Be concise and specific about the matter at hand.
05
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06
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07
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The notice form 12 amform12doc1 is a document used to report certain information to a regulatory authority.
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