Common Contracts
2 similar Psychiatrist – Patient Services Agreement contracts
Jill Krilov, MDPsychiatrist – Patient Services Agreement • June 7th, 2017
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. A separate document which will be provided for your review contains summary information about the Health Insurance Portability and Accountability Act (HIPPA), a new federal law that provides new privacy protection and new 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. HIPPA requires that I provide you with a Notice of Privacy Policy (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is attached to this Agreement, explains HIPPA 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 at the end of this session. Although these documents are long and
Jill Krilov, MD 116A Clayton Avenue Vestal, NY 13850Psychiatrist – Patient Services Agreement • March 7th, 2017
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. A separate document which will be provided for your review contains summary information about the Health Insurance Portability and Accountability Act (HIPPA), a new federal law that provides new privacy protection and new 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. HIPPA requires that I provide you with a Notice of Privacy Policy (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is attached to this Agreement, explains HIPPA 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 at the end of this session. Although these documents are long and
