ASSESSMENT & PSYCHOTHERAPY SERVICES AGREEMENTAssessment & Psychotherapy Services Agreement • May 11th, 2020
Welcome to West Chester University (WCU) Community Mental Health Services (CMHS). This agreement contains important information about 1) our professional services and special conditions related to being a training site, 2) summary information about the Health Insurance Portability and Accountability Act (HIPAA) and confidentiality, 3) our communication policy, 4) our grievance procedures, and 5) our business practices. It is important that you read it carefully before our next session and ask any questions you might have when we meet again. You will receive a copy of this notice. HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of Protected Health Information (PHI) for treatment, payment and health care operations. The Notice, which is attached to this agreement, explains HIPAA and its application to your PHI in greater detail. The law requires that we obtain your signature today acknowledging that we have provided you with this
