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HIPAA Notice of Privacy Practices
Required notice informing patients of their rights under HIPAA and how their protected health information may be used and disclosed.
PDF TemplateUse the instructions below to complete this form
Instructions
Include all elements required by 45 CFR 164.520: patient rights, covered entity duties, permitted uses and disclosures, complaint procedures, and contact information for the privacy officer. Provide the notice at the first point of service. Obtain a written acknowledgment of receipt from the patient. Update the notice whenever material changes are made to privacy practices.