TREATMENT AGREEMENT. Welcome to my practice! This document (The Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPPA), the federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment and health care operations. HIPPA requires that I provide you with Notice of PRIVACY Practices (the Notice) for the use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is included with this Agreement, explains HIPPA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I provided you with this information at the start of treatment. Although these documents are long and sometimes complex, it is important that you read them carefully. You will also receive a copy of this information to keep. We can discuss any questions you have about them after you have read them. Please make sure to let me know if there is any part that you do not understand. When you sign this document, it will also represent an agreement in writing at any time. That revocation will be binding on me unless I have taken action concerning it, re: if there are obligations imposed on me by your health insurer in order to process or substantiate claims made under your policy or if you have not satisfied any financial obligations you have incurred.
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Samples: Treatment Agreement, Treatment Agreement, Treatment Agreement
TREATMENT AGREEMENT. Welcome to my practice! . This document (The the Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPPAHIPAA), the federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment and health care operations. HIPPA HIPAA requires that I provide you with a Notice of PRIVACY Privacy Practices (the Notice) for the use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is included with this Agreement, explains HIPPA HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information at the start of treatment. Although these documents are long and sometimes complex, it is very important that you read them carefully. You will also receive a copy of this information to keep. We can discuss any questions you have about them after you have read them. Please them and please make sure to let me know if there is any part that you do not understand. When you sign this document, it will also represent an agreement between us. You may revoke this agreement in writing at any time. That revocation will be binding on me unless I have taken action concerning in reliance on it, re: ; if there are obligations imposed on me by your health insurer in order to process or substantiate claims made under your policy policy; or if you have not satisfied any financial obligations you have incurred.
Appears in 1 contract
Samples: Treatment Agreement
TREATMENT AGREEMENT. Welcome to my practice! . This document (The the Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPPAHIPAA), the federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment and health care operations. HIPPA HIPAA requires that I provide you with a Notice of PRIVACY Privacy Practices (the Notice) for the use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is included with this AgreementAgreement or can be found on my web site Forms page, explains HIPPA HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information at the start of treatment. Although these documents are long and sometimes complex, it is very important that you read them carefully. You will I would suggest that you also receive download and print a copy of this information to keep. We can discuss any questions you have about them after you have read them. Please them and please make sure to let me know if there is any part that you do not understand. When you sign this document, it will also represent an agreement Agreement, or Contract, between us. You may revoke this Agreement in writing at any time. That revocation will be binding on me unless I have taken action concerning in reliance on it, re: ; if there are obligations imposed on me by your health insurer in order to process or substantiate claims made under your policy policy; or if you have not satisfied any financial obligations you have incurred.
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