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Covered entities may use this form or any other form that complies with HIPAA the Texas Medical Privacy Act and other applicable laws. Richard Senyszyn MD Psychiatry for Adults 1260 River Acres Drive New Braunfels TX 78130 830-730-5920 Fax. 154 d. This form is intended for use in complying with the requirements of the Health Insurance Portability and Accountability Act and Privacy Standards HIPAA and the Texas Medical Privacy Act Texas Health Safety Code Chapter 181. NAME OF PATIENT OR...

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