Intake Forms- ACKNOWLEDGEMENT July 18, 2011 By Maunalani Staff Maunalani Nursing & Rehabilitation Center ACKNOWLEDGEMENT I hereby acknowledge that I have been provided with a copy of the Resident Manual including the Notice of Privacy Practices by Maunalani Nursing and Rehabilitation Center which describes how my medical information, reports and records may be used or disclosed by Maunalani Nursing and Rehabilitation Center to carry out treatment, payment or healthcare operations.Name of Resident or Representative* First Last Signature of Resident or Representative* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Relationship to Resident Share this:FacebookTwitterLinkedIn
