Common Contracts
1 similar Please Complete And contracts
PLEASE COMPLETE AND RETURN THE LAST PAGE TO DR. PADDOCKPlease Complete And • July 13th, 2020
This Agreement contains important information about me, my professional services, and my business policies. 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 I provide you with a Notice of Privacy Practices 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. You may revoke this Agreement in writing at any time.
