Common Contracts
2 similar Patient Agreement contracts
PATIENT AGREEMENTPatient Agreement • September 22nd, 2021
We are required by federal and state laws to maintain the privacy of your child’s ‘Protected Health Information’, PHI. Your signature below indicates you have received a copy of the ‘Notice of Privacy Practices and Your Rights”, which describes how health care information about your child may be collected, used and disclosed for purposes of treatment or payment or for other specified purposes that are permitted and required by law. This notice also details how you may access this information.
PATIENT AGREEMENTPatient Agreement • December 7th, 2020
We are required by federal and state laws to maintain the privacy of your child’s ‘Protected Health Information’, PHI. Your signature below indicates you have received a copy of the ‘Notice of Privacy Practices and Your Rights”, which describes how health care information about your child may be collected, used and disclosed for purposes of treatment or payment or for other specified purposes that are permitted and required by law. This notice also details how you may access this information.
