Notice of Privacy Practice for Marwood Nursing and Rehab

Form 5 of 12

GOOD FAITH EFFORT TO DELIVER NOTICE OF PRIVACY PRACTICES

Please click here to review the McLaren Health Care Notice pf Privacy Practices (NPP)

Note: Fields marked with an * indicates required field

If signing on the Residents behalf, please provide the Resident's name in the Resident section.



Please see the Marwood Nursing & Rehab receptionist for a copy of the NPP.

By submitting this Authorization, please be aware that an electronic signature is as legally binding as a handwritten signature.