Common Contracts
1 similar Psychologist – Patient Services Agreement contracts
PSYCHOLOGIST – PATIENT SERVICES AGREEMENTPsychologist – Patient Services Agreement • June 20th, 2019
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 we 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 copy in the office, on my website (www.psychologistinomaha.com), and one can be printed for you upon request. The Notice explains HIPAA and its application to your personal health information in greater detail. The law requires that we obtain your signature acknowledging that we have provided you with this information.
