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ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES hereby acknowledge that I received a copy of this medical practices Notice of Privacy Practices. I further acknowledged that a copy of the
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Obtain an acknowledment of receipt of form from the appropriate source.
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Acknowledgment of receipt of is a formal declaration that a document or item has been received.
Anyone who receives a document or item and wants to formally acknowledge its receipt.
Fill in your personal details, the date and description of the document or item received, and sign the acknowledgment.
The purpose is to provide a written record of the fact that a document or item was received by the intended recipient.
The date of receipt, description of the document or item received, recipient's name and signature.
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