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HIPAA PRIVACY ACT (PRINT CLEARLY) Patients Full Name: Social Security No.: DOB: Home Phone #: Cell phone #: Spouse Full Name: Social Security #: DOB: Spouses Phone#: 2nd Phone # Email Address: Guardian
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How to fill out methods for de-identification of
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Methods for de-identification are used to remove or mask personal identifying information from data.
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Any organization or entity that handles personal data and needs to protect individual privacy may be required to file methods for de-identification.
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