Therapist Patient AgreementTherapist Patient Agreement • October 31st, 2011
This Agreement contains important information about professional services and business policies of Courtney Linsenmeyer-O’Brien, PhD. MHR. It also contains summary information about the Health Insurance Portability and Accountability Act(HIPAA), a federal law that provides privacy protections and patient 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 we provide you with a Notice of Privacy Practices for use and disclosure of Protected Health Information (PHI). The Notice, which is attached to this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information. It is very important that you read all these documents carefully. You can discuss any questions you have about the procedures with me at any time.
Chicago PsychologicalTherapist – Patient Agreement • July 10th, 2015
