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GAS #121Mgd Eff. Date for Rev. 11/14 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

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7. If required, sign and date the form in the designated area. Some forms may require additional signatures from other parties involved, so make sure you follow the instructions correctly.
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1. Individuals or organizations that are required by law or regulation to provide a certain notice or report to a government agency or department.
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For pdfFiller’s FAQs

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