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Item#: PRV3 

  • Size: 8.5" x 11"
  • Min/QTY: 5
  • Price: $68.60
1

ENTER INFORMATION TO CUSTOMIZE TEMPLATE

Enter your business information below then select print options on the right
2

SELECT PRINT OPTIONS

 
Cost:
$68.60
Product Cost:
$68.60

Card Icon100% satisfaction guaranteed

A clear, convenient way to inform patients of how their medical information may be used and disclosed!

  • Please note: 100 forms per pad - 5 pad minimum.
  • Personalization includes: Includes up to 5 lines of personalization, plus your privacy officer's name/title and notice effective date.

Item#: PRV3 Size: 8 1/2 X 11

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