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5 23 13 PATIENT ACKNOWLEDGMENT FORM - Piedmont HealthCare

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The document is a Patient Acknowledgment Form from Piedmont HealthCare, confirming that the patient has received the Privacy Practices notice. It includes options for patients to authorize family or friends to access their medical records or to deny such access. Additionally, it allows patients to specify what type of information can be left as a message on their preferred phone number.

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2015	4.8 Satisfied (52 Votes)
2014	4 Satisfied (55 Votes)

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