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Get HIPAA DISCLOSURE AUTH FORM

Phone #: Address: City: State: Zip Code: Privacy Officer (PO): Dr. Karly Sukut-Neppl Office Contact Person (OCP): Karly Sukut Neppl DDS ! Provided in our reception area/front desk is our Notice of Privacy Practices. It provides information about how our office may use and disclose your Protected Health Information (PHI); You have the right to review our Notice of Privacy.

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