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Raja M. Din, M.D.
PATIENT CONSENT FORM
I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPPO),
I have certain rights to privacy regarding my protected health
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Sign or submit the document as instructed.
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i understand that under is a legal statement acknowledging comprehension or agreement with a particular concept or information.
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To fill out an i understand that under statement, one typically needs to include their name, date, and signature to indicate their acknowledgment or agreement.
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