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Patient HIPAA Acknowledgement and Consent Form Neurology Associates of Kansas Patient Name Date of Birth (Patient initials) NOTICE OF PRIVACY PRACTICES. I acknowledge that I have received the practice
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Neurology Associates of Kansas is a medical practice specializing in neurological care.
Neurology Associates of Kansas staff members or the designated individual responsible for administrative tasks.
Neurology Associates of Kansas can be filled out by providing accurate and up-to-date information related to the practice.
The purpose of Neurology Associates of Kansas is to provide comprehensive neurological care to patients.
Information such as patient records, billing details, and any other relevant data pertaining to the practice.
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