Common Contracts
1 similar Patient Services Agreement contracts
Charles M. Citrenbaum, Ph.D.Patient Services Agreement • January 2nd, 2023
Welcome to my practice. This document contains important information about my professional services and business policies. It also contains a Health Insurance Portability and Accountability Act (HIPAA) notice. HIPAA is 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 explains HIPAA and its application to your personal health information. The law requires that I obtain your signature acknowledging that I have provided you with this information.
