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Acknowledgement of Receipt of Notice of Privacy Practices **You May Refuse To Sign This Acknowledgement** I have read/or received a copy of these offices Notice of Privacy Practices. Print Patient
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To fill out 'I have read or received', follow these steps:
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Start by writing the heading 'I have read or received' at the top of the form.
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Below the heading, provide the relevant details such as your name, date, and any additional information required.
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Read through the document or material carefully to ensure you understand its content.
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Once you have read or received the document, make sure to check the appropriate box or indicate your acknowledgment in the designated section.
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Keep a copy of the filled-out form for your records if necessary.

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The 'I have read or received' form is needed by various individuals or organizations in different situations:
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