Common Contracts
2 similar Psychotherapist-Patient Services Agreement contracts
PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT AND INFORMED CONSENTPsychotherapist-Patient Services Agreement • April 12th, 2022
Welcome to my practice. 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. There is a 2013 addendum to the notice that HIPPA requires I give you, which mostly has to do with my responsibility to notify you if your information has been breached (similar to what a credit card company has to do if your credit card information has been compromised). The HIPPA Notice, which is included in this Agreement, explains HIPAA and its application to your
PSYCHOTHERAPIST-PATIENT SERVICES & HIPPA AGREEMENT AND INFORMED CONSENTPsychotherapist-Patient Services Agreement • October 9th, 2019
Welcome! 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 (this notice) for use and disclosure of PHI for treatment, payment and health care operations. I also have a responsibility to notify you if your information has been breached (similar to what a credit card company has to do if your credit card information has been compromised). The HIPPA Notice, which is included in this Agreement, explains HIPAA and its application to your personal health information in detail. It also informs you about my services. The law requires that I
