![[ICO]](/icons/blank.gif){kind=icon}
![[PARENTDIR]](/icons/back.gif){kind=icon}
![[ ]](/icons/layout.gif){kind=icon}
![[DIR]](/icons/folder.gif){kind=icon}
| Name | Last modified | Size | Description |
|---|---|---|---|---|
| Parent Directory | - | ||
| consent_and_insurance_info.pdf | 2021-06-28 12:59 | 2.5M | |
| patient_info.pdf | 2021-06-28 12:59 | 2.5M | |
| HIPAA_notice.pdf | 2021-06-28 12:59 | 1.7M | |
| NOTICE OF PRIVACY PRACTICES.pdf | 2021-06-28 12:59 | 416K | |
| Patient Registration Form Eat Street Dental.pdf | 2021-06-28 12:59 | 303K | |
| Instructions for website changes.pdf | 2021-06-28 12:59 | 249K | |
| NOTICE OF NONDISCRIMINATION.pdf | 2021-06-28 12:59 | 228K | |
| CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION.pdf | 2021-06-28 12:59 | 218K | |
| Medical_History_Form.pdf | 2021-06-28 12:59 | 205K | |
| Consent_Form.pdf | 2021-06-28 12:59 | 185K | |
| AWKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES.pdf | 2021-06-28 12:59 | 173K | |
| HIPPA_Notice_of_Privacy.pdf | 2021-06-28 12:59 | 149K | |
| registration_form.pdf | 2021-06-28 12:59 | 147K | |
| HIPAA_signature_page.pdf | 2021-06-28 12:59 | 101K | |
| old/ | 2021-06-28 12:58 | - | |