Effective Date, Restrictions, and Changes to Privacy Policy. This notice will go into effect on April 16, 2003. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. We will provide you with a revised notice by mail.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice goes into effect on April 15, 2003.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice will go into effect on January 1, 2016.
Effective Date, Restrictions, and Changes to Privacy Policy. The policies and procedures set forth in this notice went into effect on August 01, 2016.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice will go into effect on January 1, 2019. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain. We will provide you with a revised notice at your request, and we will advise you of changes directly if you are in treatment at the time they occur (you may request in writing that notices be sent by mail at any time during the course of therapy, and all subsequent notices will be sent to you).
Effective Date, Restrictions, and Changes to Privacy Policy. This business reserves the right to change the terms of this notice and to make the new notice provision effective for all PHI that it maintains. You will be provided with a revised notice by standard mail.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice is updated and will go into effect September 1st, 2018
Effective Date, Restrictions, and Changes to Privacy Policy. This notice went into effect on April 15, 2003. I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain. I will provide you with a revised notice by telephone or email contact. Signature Date xxx.xxxxxxxxxxxxxxxxxxxxxxxx.xxx xxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx 000-000-0000 COUNSELING AGREEMENT AND CANCELLATION POLICY I understand that I am entering into a confidential therapeutic counseling relationship. I understand that I have the right to terminate this relationship upon due notice to my counselor. I also understand that all fees, as outlined on the separate attached and signed sheet, are due at the time services are rendered unless previous arrangements have been made. I understand that information concerning my counseling cannot be divulged to other parties without my prior written consent unless directed by Georgia Law. Other conditions of confidentiality will be discussed during the initial session.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice went into effect on April 15, 2003. I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain. I will provide you with a revised notice by telephone or email contact. Signature Date xxx.xxxxxxxxxxxxxxxxxxxxxxxx.xxx xxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx 000-000-0000 COUNSELING AGREEMENT AND CANCELLATION POLICY I understand that I am entering into a confidential therapeutic counseling relationship. I understand that I have the right to terminate this relationship upon due notice to my counselor. I also understand that all fees, as outlined on the separate attached and signed sheet, are due at the time services are rendered unless previous arrangements have been made. I understand that information concerning my counseling cannot be divulged to other parties without my prior written consent unless directed by Xxxxxxx Xxx. Other conditions of confidentiality will be discussed during the initial session.
Effective Date, Restrictions, and Changes to Privacy Policy. This notice went into effect on August 1, 2004. I reserve the right to change
