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Grossman Orthopedic Medical Group Date: Patient Name: Date of Birth: Acknowledgement of Receipt of Notice of Privacy Practices I hereby acknowledge that I have received a copy of GROSSMAN Orthopedic
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Signature formupdated 121514 is a document used to collect and authenticate signatures for a specific purpose.
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The purpose of signature formupdated 121514 is to ensure the authenticity and validity of signatures collected for a specific purpose.
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