Common Contracts
1 similar Client Information Agreement contracts
Information for ClientsClient Information Agreement • April 13th, 2017
Welcome to my practice. I appreciate your giving me the opportunity to be of help to you and your family. I look forward to us working together. This document (the Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections and new patients 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 require that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for testament, payment, and health care operations. The Notice, which is also included in this packet, 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
