REBECCA M. CRABB, Ph.D.And Treatment Agreement • August 6th, 2017
Welcome! This document contains important information about the professional services and business policies of Rebecca M. Crabb, Ph.D. Please read this document carefully and ask me any questions that you have before signing.
ContractAnd Treatment Agreement • December 23rd, 2020
PARTIAL ASSIGNMENT OF CAUSE OF ACTION, ASSIGNMENT OF PROCEEDS, CONTRACTUAL LIEN, AND TREATMENT AGREEMENT, and Treatment Agreement • June 5th, 2014
Consideration: In order to facilitate the ability of the Office to collect its charges directly from various payers and thereby to enhance the patient-provider relationship, I, the undersigned, as consideration for the office’s services, agree to the following and direct all payers as follows:
CLIENT INFORMATION AND TREATMENT AGREEMENTAnd Treatment Agreement • July 27th, 2013
Since you are a new client, it is important that I provide you with some information about your treatment, your rights, and my office policies. Please read the following form. I will be pleased to respond to any questions you may have regarding any of this information.
CLIENT INFORMATION AND TREATMENT AGREEMENTAnd Treatment Agreement • February 22nd, 2010
This document (the Agreement) contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law that provides privacy protections and client 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 included with 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. Although these documents are long and sometimes complex, it is very important that you read them carefully. We can discuss any questions
