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This document is a notice of privacy practices from a county health department. It acknowledges that the client has received a notice explaining how their protected health information may be used or disclosed. The notice is subject to change and the client can check the county website or ask staff for an updated version. The client and guardian sign to acknowledge receiving the current privacy practices notice from the county health department.
This document is a notice of privacy practices from a county health department. It acknowledges that the client has received a notice explaining how their protected health information may be used or disclosed. The notice is subject to change and the client can check the county website or ask staff for an updated version. The client and guardian sign to acknowledge receiving the current privacy practices notice from the county health department.
This document is a notice of privacy practices from a county health department. It acknowledges that the client has received a notice explaining how their protected health information may be used or disclosed. The notice is subject to change and the client can check the county website or ask staff for an updated version. The client and guardian sign to acknowledge receiving the current privacy practices notice from the county health department.
Notice of Privacy Practices By signing this form, you acknowledge receipt of the Notice of Privacy Practices from the (County Health Department). The Notice of Privacy Practices provides information about how we may use and disclose your protected health information. We encourage you to review it carefully. The Notice of Privacy Practices is subject to change. If the Notice is changed, you may obtain a revised copy by visiting our website at (insert county website address) or on request from our staff. I acknowledge receipt of the Notice of Privacy Practices from (insert County Health Department) Public Health.