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Get FL HIPAA Training Certification Form 2007-2024

See instructions on page 2. 3. CHECK the boxes (in the ▼ column) to indicate the material you reviewed, and indicate the DATE for each. 4. SIGN the form. In addition to your name and signature, be sure to indicate your home department, employee/student ID or SSNo, and your supervisor’s name. 5. SEND the completed form to the Privacy Office: P.O. Box 019132 (M-879), Miami FL 33101. Faxes are not acceptable. ▼ DATE COURSE TITLE PRIVACY SERIES Federal and State Health Privacy Requiremen.

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