Common Contracts
2 similar Outpatient Services Agreement contracts
Mailing: 5610 Kitsap Way Suite 350; Bremerton, WA 98312Outpatient Services Agreement • June 16th, 2017
Welcome to my practice. This document contains important information about my professional services and business practices. It also contains summary information about Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purposes of treatment, payment, and health care operations. HIPAA requires that I provide you with a Washington State Notice of Privacy Practices Form that explains 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 end of our first session. Although these documents are long and complex, it is very important that you read them all before our next session. Please note any questions that you might have so that we can discuss them further. After reading this
Deana Enebo, M.A. LMHC Counseling ServicesOutpatient Services Agreement • October 2nd, 2014
Welcome to my practice. This document contains important information about my professional services and business practices. It also contains summary information about Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purposes of treatment, payment, and health care operations. HIPAA requires that I provide you with a Washington State Notice of Privacy Practices Form that explains 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 end of our first session. Although these documents are long and complex, it is very important that you read them all before our next session. Please note any questions that you might have so that we can discuss them further. After reading this
