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Directory Results for PATIENT NAME: DATE OF BIRTH: HIPAA Notice of Privacy Practices to Patient Name: Date of Birth: I, the undersigned, have been ined that in the event the insurance company sends the reimbursement check to me, the insured, I am responsible for signing said check over to The Center for Surgical

PATIENT NAME: DATE OF BIRTH: HIPAA Notice of Privacy Practices
Patient Name: Date of Birth: I acknowledge that Larry M ...
Patient Name: Date of Birth: I, the undersigned, have been ined that in the event the insurance company sends the reimbursement check to me, the insured, I am responsible for signing said check over to The Center for Surgical