TREATMENT AGREEMENTNew Client Information and Consent to Treatment Agreement • July 7th, 2012
Welcome to my practice. This agreement 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 client rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that clinicians provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for the above purposes. The Notice, which is attached to this Agreement, explains HIPAA and its application to your personal health information in greater detail.
