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NOTICE OF PRIVACY PRACTICES:
ACKNOWLEDGMENT OF RECEIPT
ACKNOWLEDGMENT OF RECEIPT
By signing this form, you acknowledge receipt of the Notice of Privacy Practices of Mariposa County
Health Department.
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What is notice of privacy practices?
Notice of privacy practices is a statement that describes how a medical organization may use and disclose patient information.
Who is required to file notice of privacy practices?
Healthcare providers, health plans, and healthcare clearinghouses are required to file notice of privacy practices.
How to fill out notice of privacy practices?
Notice of privacy practices can be filled out by providing information on how patient information is used, disclosed, and protected.
What is the purpose of notice of privacy practices?
The purpose of notice of privacy practices is to inform patients about their rights regarding their health information and how it may be used.
What information must be reported on notice of privacy practices?
Notice of privacy practices must include details on how patient information is collected, used, and shared, as well as the patient's rights regarding their information.
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