Common Contracts
4 similar Psychologist-Patient Services Agreement contracts
Materna Psychological Services, PC 724-346-4510Psychologist-Patient Services Agreement • April 15th, 2022
Materna Psychological Services, PC 724-346-4510Psychologist-Patient Services Agreement • April 4th, 2022
Materna Psychological Services, PC 724-346-4510Psychologist-Patient Services Agreement • March 25th, 2022
Materna Psychological Services, PC 701 N. Hermitage Rd., Suite 9Psychologist-Patient Services Agreement • October 19th, 2018
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. The Notice, which is available on-line (www.drmaterna.com) or by asking our office staff for a copy, explains HIPAA and its application to your personal health information in detail. The law requires that I obtain your signature acknowledging that I have provided you with this information at the beginning of treatment. Your signature will represent an agreement betwee
