Get the free Form 9-5: Notice of Privacy Practices Acknowledgement Receipt Form - allstatechoircamp
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Exhibit 9-5 Health Services 03/20/2012 Notice of Privacy Practices Box 19329 605 S. West St. Texas State Privacy Law (HE 300) Arlington, TX 76019 T.817.272.2771 F.817.272.3829-Page 1 of 3 www.uta.edu/healthservices
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Start filling out the form by entering your personal information accurately. This may include your name, address, contact details, and social security number.
04
Provide the date on which you are submitting the notice.
05
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