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For Office Use Only: Patient ID#: Gaffe, Rude & Associates, LLP & 65th Street GI OBS 201 East 65th Street, New York, NY 10065 & 121 East 84th Street, New York, NY 10028 Receipt of Privacy Practices
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Receipt of notice of can be filled out by providing necessary information such as name, date, and signature to acknowledge receipt.
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The purpose of receipt of notice of is to confirm that the intended recipient has received the notice or communication.
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Receipt of notice of must include details such as the date of receipt, name of recipient, and any additional relevant information mentioned in the notice.
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