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Acknowledgement privacy taylor 2025

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The document is an acknowledgment of receipt of a privacy notice from Taylor Texas Medicine, outlining how personal medical information may be used and disclosed under federal and Texas law. It includes a request for restrictions on the use of personal medical information, permission for a copy of the authorization to be used in place of the original, and instructions regarding medical insurance benefits. There are sections for patient signature, date, relationship to patient if applicable, and internal use documentation.

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