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Allergy, Asthma & Immunology Associates, P.C.
ACKNOWLEDGEMENT OF PRIVACY PRACTICES
I, ___________________________________ (patient/guardian), acknowledge that I have been informed of the Allergy, Asthma & Immunology Associates, P.C., Notice Regarding Privacy of Personal Health Information. I understand that the Notice is posted on the website www.allergyasthmaimm.com and that a paper copy of the Notice is available to me.
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Patient’s Signature |
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Date |