Common Contracts
1 similar Client Services Agreement contracts
Melody Stiles, MSW, LCSW, MAC, LCAC 7447 Glenview Drive EastClient Services Agreement • April 28th, 2016
Welcome to my practice. My practice consists of myself and I am the sole proprietor of this practice. This document contains important information about my professional services and business policies. It also contains summary information about Federal Law 42 CFR Part 2 and the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections 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. 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 is attached to this Agreement, explains HIP AA 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. In addition, feder
