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Privacy Statement

Under law, individuals are entitled to certain rights with respect to their protected health information. For your convenience, we are providing our Privacy Notice and the forms necessary for you to exercise these rights. To do so, please print, complete, and mail the appropriate form(s) to us at:

American Community Mutual Insurance Company
Attn: Privacy Coordinator
39201 Seven Mile Rd.
Livonia, Michigan 48152

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1 Privacy Notice
2 Confidential Communication Request Form
3 Amendment Request Form
4 Disclosure List Request Form
5 Request to Obtain Personal Health Information Form
6 Request to Restrict Personal Health Information Form