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CAMP – HIPAA HANDBOOK FORM
Miranda
2023-03-15T13:27:08-04:00
CAMP - Acknowledgement of Receipt of HIPAA Privacy Practices Handbook
IMPORTANT: By signing below, I acknowledge that I received a copy of ADEC's Notice of Privacy Practices effective October 1, 2014.
Please print camper's name:
(Required)
Camper's address:
(Required)
Please print parent or guardian's name, if applicable:
Signature:
(Required)
Signature of witness:
(Required)
Date:
(Required)
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