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Boston Evening Therapy Associates, LLC NOTICE OF PRIVACY PRACTICES RECEIPT AND ACKNOWLEDGMENT OF NOTICEPatient/Client Name: DOB: SSN: I hereby acknowledge that I have received and have been given
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To fill out the patient/client name, follow these steps: 1. Start by opening the patient/client form.
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Locate the field labeled 'Patient/Client Name'.
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Enter the full name of the patient/client in the designated box or text field.
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Save or submit the form to ensure the patient/client name is recorded accurately.

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By providing the patient/client name, it helps in accurately identifying and associating medical records, test results, prescriptions, and other healthcare-related information with the correct individual.
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