Other Points. If you ever become involved in a divorce or custody dispute, I want you to understand and agree that I will not provide evaluations or expert testimony in court. You should hire a different mental health professional for any evaluations or testimony you require. This position is based on two reasons: (1) My statements will be seen as biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy relationship, and I must put this relationship first. 04.13.17 Patient Name: Medical Record Number: Xxxx-Xxxxx Xxxxxxx, M.D. Apex Child, Adolescent & Adult Psychiatry, p.A. Apex, North Carolina Our Agreement I, the client (or his or her parent or guardian), understand I have the right not to sign this form. My signature below indicates that I have received this Agreement; it does not indicate that I am waiving any of my rights. I understand I can choose to discuss my concerns with you, the psychiatrist, before I start (or the client starts) formally working together and even after the work has begun. I also understand that any of the points mentioned above can be discussed and may be open to change. If at any time during the treatment I have questions about any of the subjects discussed in this brochure, I can talk with you about them, and you will do your best to answer them. I understand that after treatment begins I have the right to withdraw my consent to treatment at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with you before ending treatment with you. I understand that no specific promises have been made to me by this physician, about the results of treatment, the effectiveness of the procedures used by this doctor, or the number of sessions necessary for treatment to be effective. I have read, will read, or have had read to me, the issues and points in this Agreement. I have discussed or will discuss those points I did not understand, and will have/have had my questions, if any, fully answered. I agree to act according to the points covered in this Agreement. I hereby agree to work with this psychiatrist, and to cooperate fully and to the best of my ability, as shown by my signature here. Signature of client (or person acting for client) Date Printed name Relationship to client Signature of physician Date I truly appreciate the chance you have given me to be of professional service to you, and look forward to a successful relationship with you. If you are sa...
Other Points. As your psychologist, we cannot provide expert opinions about matters such as your parenting abilities. You should hire a different mental health professional for any evaluations or testimony you require in this regard. This position is based on two considerations: 1) Our statements may be seen as biased in your favor because we have a therapy relationship; and 2) The testimony may affect our therapy relationship, and this relationship is our first priority. Sometimes, people wonder if they could build a friendship with their psychologist during or after finishing therapy. In your best interest, and in following the American Psychological Association’s (APA’s) ethical standards, please understand that your mental health professional can only be your therapist and cannot have other roles in your life. Psychologists and other clinicians are ethically bound to avoid “dual relationships,” whenever possible. Similarly, we cannot serve as a professional therapist to someone who is already a friend. It is not ethical or legal for a psychotherapist to have a sexual or romantic relationship with any client during or after the course of therapy. In a small town especially, your psychologist may see you in the community. In the interest of protecting your confidentiality, we will generally not say hello, unless you say hello first. If you initiate conversation, we will respond, but otherwise, we will not initiate contact in public. We hope you will understand that this behavior is not intended as a personal reaction to you, but rather, this is simply intended to protect your confidentiality, in case someone present might infer that since we know you, then you must be a client. -------------------------------- YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND ALSO SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE FORM DESCRIBED ABOVE.
Other Points. It will be possible to implement purgeFromSpace within the time frame envisaged. In addition it may be possible to implement returning space tokens in srmLs. It is unlikely that we will be able to implement the additional pin lifetimes on Put and Copy specified in sections 3.1.5 and 3.1.6.
Other Points. While employees are furloughed, if men are needed at any other point, they will be given preference to transfer, with privilege of returning to home station when force is increased, such transfer to be made without expense to the Company. Qualifications and seniority to govern all cases.
Other Points. If, as part of our therapy, your child creates and provides to me records, notes, artworks, or any other documents or materials, I will return the originals to you at your written request but will retain copies. If you are unhappy with what is happening in therapy, I hope you will talk with me so that I can respond to your concerns. These comments will be taken seriously and handled with care and respect. You may also request that I refer your child to another therapist, and you are free to end therapy at any time. You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of therapy and about my specific training and experience. You have the right to expect that I will not have social or sexual relationships with clients or with former clients. OUR AGREEMENT Please initial each statement and sign below.
Other Points. This Agreement incorporates the Qualifications and Conditions (see below); where this Agreement makes provisions which are different from or incompatible with the provisions in the Qualifications and Conditions, this Agreement shall prevail. This Agreement is governed by the law of England and Wales. Any disputes must be litigated there. The description of the Claim as set out above is for recognition purposes only and does not in any way limit the ambit of this Agreement; the ambit of the retainer shall be taken to include all matters that the parties understood to be the subject of the Claim. That ambit may change from time-to-time as the Claim progresses. In particular, if an opponent is incorrectly described or if more opponents are joined after this Agreement was first made, the ambit of this Agreement will not be in any way limited by the fact that the description of the Claim as set out above may not be wholly accurate and complete. In the event that any term or condition or provision of this Agreement is held to be a violation of any applicable law or statute or regulation, the same shall be deemed to be deleted from this Agreement and shall be of no force and effect and this Agreement shall remain in full force and effect as if such term and condition or provision had not originally been contained in this Agreement. To be effective (and unless the court orders otherwise), any variation of or supplement to this Agreement must be made in writing. It is recorded that prior to signing this Agreement, the Professional Client explained the following to the Lay Client: The Lay Client’s obligations as set out under “the Lay Client’s responsibilities” (below); The circumstances in which the Counsel would seek payment; The fact that the Success Fee must be paid by the Lay Client (usually out of damages); The Lay Client’s right to an assessment of any such payment; and The general effect of the Agreement.
Other Points. Immediately before you sign this agreement, we explained to you the effect of this agreement and in particular the following:
Other Points. As your psychologist or clinician, we cannot provide expert opinions about matters such as your parenting abilities. Also, as your treating psychologist/clinician, we may not be able to offer an opinion about your disability status. You should hire a different mental health professional for any evaluations or testimony you require in this regard. This position is based on three considerations: 1) our statements may be seen as biased in your favor because we have a therapy relationship; 2) the testimony may affect our therapy relationship, and this relationship is our first priority; and 3) we do not specialize in parenting assessments. Sometimes people wonder if they could build a friendship with their psychologist or clinician during or after finishing therapy. In your best interest, and in following the American Psychological Association’s (APA’s) ethical standards, please understand that your mental health professional can only be your therapist and cannot have other roles in your life. Psychologists and other clinicians are ethically bound to avoid “dual relationships” whenever possible. Similarly, we cannot serve as a professional therapist to someone who is already a friend. It is not ethical or legal for a psychotherapist to have a sexual or romantic relationship with any client during or after the course of therapy. In a small town especially, your psychologist or clinician may see you in the community. In the interest of protecting your confidentiality, they will generally not initiate a greeting or conversation; if you initiate, your clinician will respond, but otherwise, they will not initiate contact in public. We hope you will understand that this behavior is not intended as a personal reaction to you, but rather is simply intended to protect your confidentiality. -------------------------------- HIPAA “Final Rule” Additions Effective Sept. 23, 2013 Health Psych Maine will also obtain an authorization from you before using or disclosing Protected Health Information (PHI) in a way that is not described in this Notice. Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket. You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket in full for services at Health Psych Maine. Right to Be Notified if There is a Breach of Your Unsecured PHI. You have a right to be notified if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your...
Other Points. 12.1 Expressions and definitions of words used in this CFA are explained in the attached Terms & Conditions.
Other Points. This contract does not constitute an employer-employee relationship. The student will receive € per month for the period of the contract. Place, date: Placement provider: Signature Seal TH Wildau: Signature Seal Student: Signature
