Common Contracts
2 similar Patient Services Agreement contracts
Lisa A. Wuyek, Ph.D.Patient Services Agreement • October 6th, 2021
This document contains important information about my professional services and business policies. It also contains summary information about the Health Information Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment, health care operations. The Notice contains a description of HIPAA and its application to your PHI. I am required to obtain your signature acknowledging that I have provided you with this information prior to your first session.
Lisa A. Wuyek, Ph.D.Patient Services Agreement • December 11th, 2012
This document contains important information about my professional services and business policies. It also contains summary information about the Health Information Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment, health care operations. The Notice contains a description of HIPAA and its application to your PHI. I am required to obtain your signature acknowledging that I have provided you with this information prior to your first session. We can discuss any questions you have about the procedures at that time. When you sign this document, it will also represent an agreement between us. You may revoke this agreement in writing at any time. That re
