Informed Consent Service AgreementConsent Service Agreement • March 9th, 2021
information about my 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 patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations.
Informed Consent Service AgreementConsent Service Agreement • February 15th, 2020
Welcome to Blackburn Counseling. This document contains important information about my 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 patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations.
Consent, Service Agreement, and Financial AuthorizationConsent, Service Agreement • November 9th, 2023
World of Words Speech & Feeding Services LLC (the Agency) is my primary home care agency. I understand it is licensed to provide Personal Assistance Services and I accept these services from the Agency. I know I can be involved in my care and I can work with the Supervisor to develop my Individualized Service Plan (ISP). It has been explained to me what the Attendant/Caregiver can and can't do for me.
