Common Contracts
1 similar Summary of Agreement contracts
Please initial each section I understand that Dr Heitt requires 48 hours advance notice of cancellations and that I - not my insurance company - will be responsible for the full fee of missed sessions. I understand payment of professional fees and/or...Summary of Agreement • September 14th, 2010
Welcome to the office of Heitt Clinical & Corporate Consulting, LLC. This document (the 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 went into effect in April 2003 and provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) 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 greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information by the end of your initial consultation session. When you sign this document, it will also represent an agreem
