Common Contracts
1 similar Treatment Agreement contracts
Treatment AgreementTreatment Agreement • March 5th, 2018
Privacy Policy and Client Rights and Responsibilities: The privacy of your medical information is important to us and we are committed to protecting it. A record of your care will be created for the services received while a patient at our office. This record is necessary to provide you with quality care and to comply with certain legal requirements. Your medical information may be disclosed to other treating providers at your request, your insurance company to assist in payment of your claim and to pharmacies to assist in obtaining your medications. Full notice of our privacy policy is posted on our waiting room wall. You are being given a copy of your rights and responsibilities. My signature on this form acknowledges I have read this policy and have been informed of the privacy policy of this office.
