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.l ason $chwcitzer, L,lCSlrl, L,icenscd Independent Clinical $or;ial Morker4:21 Ist Avenue fiW Suite 300W, llochester, l4N 55g02 : r\'507) 2\'/ 1 0461 Web: www.counse llin gwith.j ason.conrPhNotice of Privacy practices & Electronic Payment communisltions Disclosure Ror:eipt and Acknowledgment of NoticeClient Name: DOB: SSN:I hereby acknowledge that I have received and hiave been given an opportunity to read a copy of Jason Schweitzeros Notice of llrivacy Piactices and ElectronicPaymetrt...
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