Common Contracts
2 similar Psychotherapist-Patient Services Agreement contracts
GARY S. KATZ, PH.D. A PROFESSIONAL PSYCHOLOGY CORPORATION GARY S. KATZ, PH.D. 509 MARIN STREET SUITE 236 CLINICAL PSYCHOLOGISTPsychotherapist-Patient Services Agreement • January 15th, 2015
Lori Chortkoff Hops, Ph.D. Clinical Psychologist PSY 14335 PSYCHOTHERAPIST- PATIENT SERVICES AGREEMENTPsychotherapist-Patient Services Agreement • October 26th, 2014
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 in a separate document, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information at the end of this session. Although these documents are long and sometimes complex, it is very important that you read them car
