Common Contracts
1 similar Psychologist-Patient Services Agreement contracts
PSYCHOLOGIST-PATIENT SERVICES AGREEMENTPsychologist-Patient Services Agreement • August 17th, 2009
Welcome to my practice. I am pleased to have the opportunity to work with you. As we begin our work together, it is important that we have a shared understanding of what we can expect from each other. 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 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 (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which you were also given today, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledgin
