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Get Il Schnack Chiropractic Center Patient Consent For Use And/or Disclosure Of Protected Health 2010-2024

, hereby states that by signing this Consent, I acknowledge and agree as follows: 1. The Practice's Privacy Notice has been provided to me prior to my signing this Consent. The Privacy Notice includes a complete description of the uses and/or disclosures of my protected health information ("PHI") necessary for the Practice to provide treatment to me, and also necessary for the Practice to obtain payment for that treatment and to carry out its health care operations. The Practice explained to m.

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