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Acknowledgement of Privacy Practices Patient First Name Patient Last Name Birthday mm/dd/YYY certify that I have received a copy of South Park Pediatric Dentistry's Notice of Privacy Practices Signature
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i certify that i is a statement made to confirm the truthfulness and accuracy of a particular claim or document.
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Individuals or entities who are submitting official documents or making specific claims may be required to file i certify that i.
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To fill out i certify that i, one must typically read and understand the statement being certified, then sign and date the document to confirm its accuracy.
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The purpose of i certify that i is to provide a legal affirmation that the information being presented is truthful and accurate.
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