alex m. pentino, dds 107 plaza drive suite f st. clairsville, oh 43950 acknowledgement of receipt of...

4

Upload: others

Post on 09-May-2020

0 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Alex M. Pentino, DDS 107 Plaza Drive Suite F St. Clairsville, OH 43950 ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES * You May Refuse to Sign This Acknowedgement* have
Page 2: Alex M. Pentino, DDS 107 Plaza Drive Suite F St. Clairsville, OH 43950 ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES * You May Refuse to Sign This Acknowedgement* have
Page 3: Alex M. Pentino, DDS 107 Plaza Drive Suite F St. Clairsville, OH 43950 ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES * You May Refuse to Sign This Acknowedgement* have
Page 4: Alex M. Pentino, DDS 107 Plaza Drive Suite F St. Clairsville, OH 43950 ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES * You May Refuse to Sign This Acknowedgement* have