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![[PARENTDIR]](/icons/back.gif){kind=icon}
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| Name | Last modified | Size | Description |
|---|---|---|---|---|
| Parent Directory | - | ||
| registration_form.pdf | 2012-07-09 11:16 | 147K | |
| patient_info.pdf | 2013-01-17 12:33 | 2.5M | |
| consent_and_insurance_info.pdf | 2013-01-17 12:33 | 2.5M | |
| Patient Registration Form Eat Street Dental.pdf | 2015-12-03 14:50 | 303K | |
| NOTICE OF PRIVACY PRACTICES.pdf | 2016-10-11 11:15 | 416K | |
| NOTICE OF NONDISCRIMINATION.pdf | 2016-10-11 11:15 | 228K | |
| Medical_History_Form.pdf | 2012-07-09 12:10 | 205K | |
| Instructions for website changes.pdf | 2016-10-11 11:15 | 249K | |
| HIPPA_Notice_of_Privacy.pdf | 2012-07-09 12:10 | 149K | |
| HIPAA_signature_page.pdf | 2012-07-09 12:10 | 101K | |
| HIPAA_notice.pdf | 2013-01-17 12:33 | 1.7M | |
| Consent_Form.pdf | 2012-07-09 12:09 | 185K | |
| CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION.pdf | 2016-10-11 11:16 | 218K | |
| AWKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES.pdf | 2016-10-11 11:15 | 173K | |