Form preview

Get the free acknowledgement of receipt of notice of privacy practices for ...

Get Form
ACKNOWLEDGEMENTOFRECEIPTOFNOTICEOFPRIVACYPRACTICESFOR PROTECTEDHEALTHINFORMATION(HIPAA) IacknowledgethatIhave()received or()declinedacopyofSurgicalSpecialistsofYorks NoticeofPrivacyPracticesforhealthinformation.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign acknowledgement of receipt of

Edit
Edit your acknowledgement of receipt of form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your acknowledgement of receipt of form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing acknowledgement of receipt of online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Here are the steps you need to follow to get started with our professional PDF editor:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit acknowledgement of receipt of. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
With pdfFiller, it's always easy to work with documents. Check it out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out acknowledgement of receipt of

Illustration

How to fill out acknowledgement of receipt of

01
To fill out an acknowledgement of receipt of, follow these steps:
02
Start by writing the current date at the top of the document.
03
Write the name and address of the person or organization receiving the acknowledgement.
04
Include a brief description of the item or document being acknowledged.
05
Indicate the date on which the item or document was received.
06
Sign your name and provide any relevant additional information, such as your title or contact information.
07
If necessary, have a witness sign the acknowledgement as well.
08
Keep a copy of the acknowledgement for your records.

Who needs acknowledgement of receipt of?

01
Acknowledgement of receipt of is needed by individuals or organizations who want to confirm that they have received a specific item or document. This can be used in various situations, such as when receiving a package, signing for a legal document, or acknowledging the receipt of payment.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.6
Satisfied
31 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

People who need to keep track of documents and fill out forms quickly can connect PDF Filler to their Google Docs account. This means that they can make, edit, and sign documents right from their Google Drive. Make your acknowledgement of receipt of into a fillable form that you can manage and sign from any internet-connected device with this add-on.
It's simple using pdfFiller, an online document management tool. Use our huge online form collection (over 25M fillable forms) to quickly discover the acknowledgement of receipt of. Open it immediately and start altering it with sophisticated capabilities.
With pdfFiller, you may not only alter the content but also rearrange the pages. Upload your acknowledgement of receipt of and modify it with a few clicks. The editor lets you add photos, sticky notes, text boxes, and more to PDFs.
Acknowledgement of receipt of is a document that serves as proof that a certain item or information has been received.
Anyone who receives a document or item and needs to acknowledge its receipt may be required to file an acknowledgement of receipt.
Acknowledgement of receipt of can typically be filled out by providing the date of receipt, the name of the recipient, and any additional relevant information.
The purpose of acknowledgement of receipt of is to establish a record that a certain item or information has been received by the intended recipient.
The information reported on acknowledgement of receipt of typically includes the date of receipt, the name of the recipient, a description of the item or information being received, and any relevant details.
Fill out your acknowledgement of receipt of online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.