Notice of privacy practices acknowledgement form 2025

1. Click ‘Get Form’ to open the notice of privacy practices acknowledgement form in the editor.
2. Begin by reading the document carefully to understand your rights regarding privacy practices. This is crucial for informed consent.
3. In the 'Signed' field, enter your signature. If you are signing on behalf of someone else, ensure you indicate your relationship in the designated section.
4. Fill in the 'Print Name' and 'Telephone' fields with your details for identification purposes.
5. If applicable, specify the name of the patient in the provided space. This is important for record-keeping.
6. For office use, ensure that any additional notes regarding acknowledgment refusal or efforts to obtain are filled out as necessary.

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