Common Contracts
1 similar Psychologist-Patient Services Agreement contracts
PSYCHOLOGIST-PATIENT SERVICES AGREEMENTPsychologist-Patient Services Agreement • June 9th, 2020
Welcome to our practice, the Center for Psychology and Learning, LLC (CPAL). This document (the Agreement) contains important information about CPAL 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 new 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 also 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 attached to this Agreement, explains HIPAA and its application to your personal health information and/or your child’s health information in greater detail. The law requires that we obtain your signature acknowledging that we have provided you with this information. Although these doc
