Common Contracts
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PSYCHOTHERAPIST-PATIENT SERVICES & HIPPA AGREEMENT AND INFORMED CONSENTOctober 9th, 2019
Welcome! 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 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 I provide you with a Notice of Privacy Practices (this notice) for use and disclosure of PHI for treatment, payment and health care operations. I also have a responsibility to notify you if your information has been breached (similar to what a credit card company has to do if your credit card information has been compromised). The HIPPA Notice, which is included in this Agreement, explains HIPAA and its application to your personal health information in detail. It also informs you about my services. The law requires that I
