Common Contracts
5 similar Provider-Patient Services Agreement contracts
HRC PROVIDER-PATIENT SERVICES AGREEMENTProvider-Patient Services Agreement • April 9th, 2024
Your signature on the HRC SIGNATURE PAGE indicates that you have 1) been given this agreement and 2) read and agree to its terms. It also serves as an acknowledgement that you have received the HRC PRIVACY NOTICE of HRC Policies and Practices to Protect the Privacy of your Health Information.
HRC PROVIDER-PATIENT SERVICES AGREEMENTProvider-Patient Services Agreement • November 6th, 2022
Your initial session(s) will involve an evaluation of your needs. By the end of the evaluation, your provider will be able to offer you some first impressions of what your work will include and a plan to follow, if you decide to continue with our services. You should evaluate this information along with your own opinions of whether you feel comfortable working with your provider. Treatment/consultation involves a commitment of time, money, and energy, so you should be careful about the provider you select. If you have questions about procedures, they should be discussed with your provider whenever they arise. If your doubts persist, your provider will be happy to help you set up a meeting with another professional for a second opinion.
HRC PROVIDER-PATIENT SERVICES AGREEMENTProvider-Patient Services Agreement • March 16th, 2017
Welcome to HRC. This document contains important information about our practice and its business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law designed to protect your privacy and your 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. HIPAA requires that we provide you with the attached Notice of Privacy Practices that explains HIPAA and how it affects you. The law also requires that we obtain your signature acknowledging that you have received this information. Although these documents are long and sometimes complex, it is very important that you read them carefully. We can address any questions you have about the procedures before your next session. When you sign this document, it will also represent an agreement between you, your provider, and HRC. You may revoke this Agreement in writing a
HRC PROVIDER-PATIENT SERVICES AGREEMENTProvider-Patient Services Agreement • March 18th, 2016
Your initial session(s) will involve an evaluation of your needs. By the end of the evaluation, your provider will be able to offer you some first impressions of what your work will include and a plan to follow, if you decide to continue with our services. You should evaluate this information along with your own opinions of whether you feel comfortable working with your provider. Treatment/consultation involves a commitment of time, money, and energy, so you should be careful about the provider you select. If you have questions about procedures, they should be discussed with your provider whenever they arise. If your doubts persist, your provider will be happy to help you set up a meeting with another professional for a second opinion.
HRC PROVIDER-PATIENT SERVICES AGREEMENTProvider-Patient Services Agreement • July 16th, 2008
Welcome to HRC. This document contains important information about our practice and its business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law designed to protect your privacy and your 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. HIPAA requires that we provide you with the attached Notice of Privacy Practices that explains HIPAA and how it affects you. The law also requires that we obtain your signature acknowledging that you have received this information. Although these documents are long and sometimes complex, it is very important that you read them carefully. We can address any questions you have about the procedures before your next session. When you sign this document, it will also represent an agreement between you, your provider, and HRC. You may revoke this Agreement in writi
