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Personalized Notice of Privacy Practices HIPAA Acknowledgment
Personalized Notice of Privacy Practices HIPAA Form
 
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List Price: $95.00
Your Price: $67.00
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Unit Qty: 125
Unit: pack
Overall Dimensions: 5 1/2 X 8 1/2


Product Code: PRV2-DFS

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Personalized Notice of Privacy Practices HIPAA Acknowledgment 3 Parts
A clear, compact form that documents patient receipt of your privacy policy.
Personalization includes: Your imprinted practice name, address, and phone number, up to 5 lines. 3-part form provides copies for patient, chart and privacy officer.
   Please note: 25 forms per pad - 5 pad minimum.

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