HIPPA Acknowledgement of Receipt of Notice of Privacy Practice (NPP)

Labpreps - A Mobile Healthcare Business

Acknowledgement of Receipt of Privacy Practice

Personal Information

I acknowledge that I have been offered and/or received a copy of Labprep's Notice of Privacy Practices, which describes how my health information may be used and disclosed and how I can access my information.

For Office Use Only (if patient declines/refuses to sign)

Labpreps attempted to obtain written acknowledgement of receipt of the NPP, but it could not be obtained because: