Common Contracts
1 similar Individual Service Agreement contracts
INDIVIDUAL SERVICE AGREEMENT AND PAYMENT AUTHORIZATION FOR FOSTER CHILD PLACED OUT OFCOUNTYIndividual Service Agreement • November 8th, 2020
This Agreement is entered into on __________________Agreement date between the County of _____________ hereinafter referred to as “County” and ______________________, hereinafter referred to as “Contractor” for __________________ (hereinafter referred to as ” Foster Child client” for access to Medi-Cal Specialty Mental Health services. Contractor is located in the County of ________________ and is certified by this County to provide Medi-Cal services, as evidenced by a copy of Certification attached. A copy of Professional Liability Insurance is also attached.
