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PATIENT ACKNOWLEDGMENT AND CONSENT I have been given a copy of Blue Ridge Pediatrics, Laps Notice of Privacy Practices, version effective. I consent to the uses and disclosures of my children health
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Read through the privacy practices carefully to understand your rights and the organization's obligations.
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Who needs receipt of privacy practices?

01
Patients or clients of healthcare providers – individuals who receive medical or healthcare services.
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Consumers of financial institutions – individuals who have a banking or financial relationship with a company.
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Participants of research studies or clinical trials – individuals who volunteer or participate in scientific research.
04
Customers or clients of businesses handling sensitive personal information – individuals who share their personal data with an organization.
05
Employees of companies or organizations – individuals who work for a company and have access to sensitive or confidential information.
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The receipt of privacy practices is a document that provides information to individuals about how their personal information is collected, used, and protected by an organization.
Any organization that collects or stores personal information from individuals is required to provide a receipt of privacy practices to those individuals.
The receipt of privacy practices should be filled out by providing clear and concise information about the organization's privacy policies, data collection practices, and how individuals can exercise their privacy rights.
The purpose of the receipt of privacy practices is to inform individuals about how their personal information is being handled by an organization and to ensure transparency and compliance with privacy laws.
The receipt of privacy practices must include information about the types of personal information collected, how it is used, who it is shared with, and how individuals can access or request changes to their personal information.
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