Acknowledgment of Receipt of Notice of Privacy Practices

Acknowledgment of Receipt of Notice of Privacy Practices
I acknowledge that I have received a copy of the Human Services Coalition of Tompkins County Notice of Privacy Practices (NPP). 

I understand that this organization has the right to change its NPP from time to time, and that I may contact this organization to obtain a current copy of the NPP. 

I also understand that I have the right to access my care record and to make complaints to the organization or the U.S. Department of Health and Human Services (HHS) if I believe my privacy rights have been violated. 
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