How often do patients need to sign a new “notice of privacy practices” form? Since the notice has just been updated, does the updated notice only need to be signed by new patients or all existing patients?

Patients do not need to sign the Notice of Privacy Practice forms itself, but instead merely an acknowledgement “I, ______________, have received/reviewed a copy of this office’s Notice of Privacy Practices.” If a patient refuses to sign which is their right the office is to document what steps they took to get the authorization. The updated notice has to only be given to new patients. It should also be posted on the website and in the office.