Acknowledgment of Receipt of Privacy Notice
By signing this form, you acknowledge that you have received or had the opportunity to review our Notice of Privacy Practices (NPP). This notice explains how your health information may be used, disclosed, and protected under HIPAA.
This acknowledgment does not authorize us to release any of your information; it only confirms that you have been informed about how your health information will be handled.
Important Information
- You may request a copy of our Privacy Notice at any time.
- If you have any questions about the Privacy Notice, please contact our Privacy Officer.
For more information, please contact our Privacy Officer:
Aimee Williamson
Phone: 251-725-0260
Email: info@ldchc.org