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Get Patient Acknowledgement Form

Uest This memo will serve as confirmation that I, , have been thoroughly briefed on all aspects of UCLA s policies regarding patient confidentiality and I understand that policy and its requirements. It is my understanding that I will be exposed to very sensitive, highly confidential demographic and clinical information. I also understand and agree that any violation of the patient confidentiality policy and any unauthorized use of any patient demographic and/or clinical data on my.

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