 |
|
|
Gastroenterology Consultants of South Jersey
Amherst Commons, Building A, Suite 2
693 Main Street, Lumberton, New Jersey
Telephone: (609) 265-1700
Visit us Online: www.GCSJ.org
|
|
|
NOTICE
OF PRIVACY PRACTICES
|
|
RECEIPT
OF NOTICE OF PRIVACY
PRACTICES
WRITTEN
ACKNOWLEDGEMENT FORM. |
I,
___________________________________________,
have received a copy of the
Gastroenterology Consultants
of South Jersey's Notice of
Privacy Practices.
Patient's Signature:
______________________________________________________________
Date: _______ / ______ / 20____
Please sign in office,
witnessed by GCSJ staff.
Thank you!
|
|
|
[Print this Page]
|
[Return to Previous Page]
|
Information was printed from http://www.GCSJ.org
Copyright © 2005 Gastroenterology Consultants of South Jersey, P.C. All Rights Reserved.
|
|
Site
designed, developed and maintained by WebWiser.com |
|
|
|
|