Common Contracts
1 similar Health Care Agreement contracts
CONSENT TO TREAT - HEALTH CARE AGREEMENTHealth Care Agreement • August 25th, 2021
I acknowledge that Austin Neuromuscular Center may release my protected health information as necessary for treatment, payment and health care operations and acknowledge that the Austin Neuromuscular Center Notice of Privacy Practices provides information on how my protected health information may be used and/or disclosed for these purposes. I understand that protected health information pertains to my diagnosis and/or treatment and includes but not limited to information related to my health history, diagnosis, treatment, prognosis, mental illnesses (exclude psychotherapy notes), use of alcohol or drugs, prescriptions, and laboratory test results, including HIV or the diagnosis of AIDS.
