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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": "For Department Use Only: Complete this section if you are unable to obtain a signature."
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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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