Common Contracts

Outpatient/IOP Admission Packet

Outpatient/Iop Admission Packet • January 27th, 2015 • California

• Contract Type
  Outpatient/Iop Admission Packet
• Filed
  January 27th, 2015
• Jurisdiction
  California

 (if used)  Credit Card Authorization  General Information  Family Information-Parents  Family Information-Siblings  Family Questionnaire  Educational Information  Treatment History  Medical History  Medications  Physicians Signature  Physical Exam    Enrollment Agreement   OPI Rules and Precepts    Authorization to Release Info to OPI    Authorization for OPI to Release Info    Activities Release    Release of Liability    Complete Release of Liability – Off Premises  Notice of Privacy Practices    Letter of Agreement Regarding the Provision of IndividualPsychiatric Consultative Services    Letter of Agreement Regarding the Provisions of Individual Psychotherapy Services   Cancellation/No Show Policy    Statement of Authenticity