Common Contracts
1 similar Therapist - Patient Services Agreement contracts
THERAPIST - PATIENT SERVICES AGREEMENT GROUP THERAPYTherapist - Patient Services Agreement • December 9th, 2011
This document (AKA “the Agreement”) contains important information about the professional services and business policies of the Center for Valued Living, PLLC and me, your therapist. It also contains summary information about the Health Insurance 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) used for the purpose of treatment, payment, and health care operations. HIPAA requires that you are provided with a Notice of Privacy Practices (AKA “the Notice”) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is attached to this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that you have provided with this information. Your signature on this form will indicate that you have received and rea
