YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at: 000 X. Xxxxxxxxx Xxxx, Xxxxx 000, Xxxxxxx, XX 00000.
Appears in 3 contracts
Samples: Therapist Client Agreement, Therapist Client Agreement, Therapist Client Agreement
YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at: 000 X. Xxxxxxxxx Xxxx, Xxxxx 000, Xxxxxxx, XX 00000.:
Appears in 1 contract
YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at: 000 X. Xxxxxxxxx Xxxx, Xxxxx 000, Xxxxxxx, XX 00000.at :
Appears in 1 contract
YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at: 000 X. Xxxxxxxxx Xxxx, Xxxxx 000, Xxxxxxx, XX 00000.at [Insert Contact Information]:
Appears in 1 contract
Samples: Client Therapist Service Agreement
YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding your personal PHI we maintain about youmaintained by our office. To exercise any of these rights, please submit your request in writing to our Privacy Officer at: 000 X. Xxxxxxxxx XxxxOfficer,_XXXX XXXXXX , at 0000 X, Xx, Xxx 00, Xxxxx 0000, XxxxxxxXxxxxxxxxxxxxx, XX Xxxxx 00000.
Appears in 1 contract
Samples: Professional Services
