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The Practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 HIPAA. You have the right to revoke this Consent in writing signed by you. However such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent. The Practice reserves the right to change the Notice of Privacy Practices. The patient has the right to restrict the uses of their information but the Practice does not have to agree to the...
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