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HIPAA Acknowledgement and Consent

Health & Wellness

Description:

If you provide health care services, you can use this form with your patients as a HIPAA acknowledgement and consent form.

How to Use this Form:

1) Download the Word Document (so that document can be edited).

2) Read through the ENTIRE AGREEMENT at least once before editing.

    (Become familiar with the form and any documents you may need).

3) Revise the HIGHLIGHTED Information as needed.

4) Delete any NOTES that may be written in.

5) And last, confirm that ALL parties identified. Execute (Sign) the Agreement.

6) Keep a COPY of the Signed Agreement in your files.