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doc12836 acknowledgement.pdf
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Page 1
24 item(s)
JSON
figure (1)
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title (1)
1 · FIGURE
2 · TITLE
3 · TEXT
4
5 · TEXT
6
7 · TEXT
8 · TEXT
9 · HEADING
10 · LIST
11
12
13
14
15
16
17
18
19 · TEXT
20
21
22 · TEXT
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Page 1 JSON
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"text": "Facility Name: Kentucky State University, Betty White Student Health Services"
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"text": "I acknowledge that I have received or been offered a copy of Kentucky State University’s (KSU) Notice of Privacy Practices (NPP) which describes how my Protected Health Information is used and shared. I understand that KSU has the right to change this NPP at any time. I may obtain a current copy by contacting KSU’s Student Health Services."
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"text": "If the patient or personal representative is unable or unwilling to sign this\nAcknowledgement, or the Acknowledgement is not signed for any other reason, state the\nreason:",
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