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FRONT / BACK view	Product Code: HIPAA

Description   Notice of Privacy Practice # HIPAA 5 Pages Color: White & Yellow 11"x 17" Folded Page 5 Signature Page / 2 Part NCR Features Dimensions: 11" x 17" and 8.5"x11" Color: White / Yellow 2 Part NCR 5 Pages Related Items Notification of Utilization Review # 3722-NCR Utilization - Determination Of Continued Stay #3734 NCR Certification And Recertification #MAR 087 Office Fund Voucher Envelope # 1171 Utilization Committee Determ. On Admission #3723 NCR Interfacility Transfer Report. 2 part NCR # 3211 Self Administration Of Drugs Assess. 2part NCR #3830 Repair Requisition # 3366 - NCR

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