CARING FOR OHANA CARING FOR YOU - Hamakua-Kohala Health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the Acknowledgement of Receipt section. This outlines your rights regarding health information and privacy practices.
3. In the Signature field, enter your signature or that of an authorized representative. Ensure this is done clearly to validate the acknowledgment.
4. Next, fill in the Date field with the current date when you are signing the document.
5. Print your name in the designated area to confirm who is signing on behalf of the patient.
6. If applicable, indicate your relationship to the patient in the provided space.
7. For internal use, if there is a refusal to sign, document the date and time notice was presented and include your name and title.

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