Denette Mann Psychotherapy Services 5580 Peterson Lane, Suite 145Client Agreement and Informed Consent for Treatment • September 9th, 2021
Client Agreement and Informed Consent for TreatmentClient Agreement and Informed Consent for Treatment • January 18th, 2020
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides for privacy protections and client rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health careoperations. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment, and health care operations. The Notice, which accompanies this agreement, explains HIPAA and its application to your personal health information in detail. As required by law, on the last page of this agreement, you are asked for your signature acknowledging that you have been provided with this information. When you sign this document, it will represent an agreement between us.
