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REQUEST TO OPT-OUT OF HEALTH INFORMATION EXCHANGE FORM Please complete, sign, and email this form to optout@ngdc.com or bring this form to our front desk staff. Full Patient Name (print): ___DOB:Street

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How to fill out request to opt-out of

01

Start by visiting the privacy policy page of the website or service you want to opt-out of.

02

Look for the section that outlines the process for opting out of data collection or marketing communications.

03

Follow the instructions provided, which may involve filling out a form, sending an email, or making a phone call.

04

Provide any necessary information such as your name, email address, and account details.

05

Be sure to confirm that your request to opt-out has been successfully processed.

Who needs request to opt-out of?

01

Anyone who wants to limit the amount of personal data collected about them or who wants to stop receiving marketing communications from a particular company.

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What is request to opt-out of?

Request to opt-out of is a formal request to exclude oneself from a certain activity or service.

Who is required to file request to opt-out of?

Any individual or entity who wishes to opt-out of a specific activity or service is required to file a request to opt-out.

How to fill out request to opt-out of?

To fill out a request to opt-out of, one must provide their personal information, state the reason for opting out, and follow any specific instructions provided by the relevant authority.

What is the purpose of request to opt-out of?

The purpose of a request to opt-out of is to formally declare one's decision to no longer participate in a particular activity or service.

What information must be reported on request to opt-out of?

The information that must be reported on a request to opt-out of typically includes personal details, reasons for opting out, and any supporting documentation, if required.

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