LCSW Name and Address] Business Associate Amendment to AgreementBusiness Associate Amendment to Agreement • December 5th, 2020
By agreement of the parties, _________________________________________ (“Covered Entity”) and ________________________________(“Business Associate”), whose signatures have been affixed below, the ___________________________________ Agreement for __________________________ Services, dated, 20__, (“Agreement”), is hereby amended as set forth herein (“Amendment”). This Amendment is effective as of, 20__ or such earlier date as this Amendment is fully signed by the parties (“Effective Date”).
