Consent for Treatment. I authorize and request my practitioner to carry out neuropsychological exams, treatment, and/or diagnostic procedures, which now, or during the course of my treatment, become advisable. I understand the purpose of these procedures will be explained to me upon my request and that they are subject to my agreement. I also understand that while the course of my treatment is designed to be helpful, my practitioner can make no guarantees about the outcome of my treatment. Further, the psychotherapeutic process can bring up uncomfortable feeling and reactions such as anxiety, sadness and anger. I understand that this is a normal response to working through unresolved life experiences and that these reactions will be worked on between my practitioner and me.
Consent for Treatment. I, or my representative, agree to have Xxxxx Xxxxxxx providers evaluate and treat my condition. Absent an emergency, if the proposed treatment has significant risks, then an additional informed consent will be obtained. I understand that the practice of medicine is not an exact science, and that no guarantees have been given to me by anyone as to the results or outcomes that may be obtained from examinations, treatments or other healthcare services.
Consent for Treatment means a process of communication between a patient or, if applicable, the patient's parent, guardian, or person designated under the patient's health care power of attorney and the health care professional discussing the risks and benefits of, and alternatives to, treatment through a remote evaluation that results in the agreement to treatment that is documented in the medical record or signed authorization for the patient to be treated through an evaluation conducted through appropriate technology, as specified in this rule, when the health care professional is in a location remote from the patient.
Examples of Consent for Treatment in a sentence
Please do not sign the certificate if you do not understand any part of the HIPAA Client’s Rights of the Professional Disclosure Statement and Consent for Treatment.
My signature below confirms that I understand and accept all the information contained in the Palmetto Counseling Associates Professional Disclosure Statement and Consent for Treatment and the HIPAA Client’s Rights.
We will provide additional copies of the Palmetto Counseling Associates Professional Disclosure Statement and Consent for Treatment and the HIPAA Client’s Rights upon request.
Signatures below confirm that each understands and accepts all the information contained in the Palmetto Counseling Associates Professional Disclosure Statement and Consent for Treatment and the HIPAA Client’s Rights, and that each seeks and consents to treatment.
This Consent for Treatment shall specifically include tests for the presences/absence of alcohol or controlled substances.
More Definitions of Consent for Treatment
Consent for Treatment. By signing this form, I am voluntarily consenting to psychotherapy, counseling, education and all other services provided by FTI. Psychotherapy has been shown to have benefits for the majority of people who undertake it. It often leads to a significant reduction of feelings of distress, better relationships, and resolution of specific problems. However, there are no guarantees about what will happen. “Risks” of therapy might include experiencing uncomfortable levels of feelings while dealing with painful issues. I understand that I can revoke this consent at any time in writing by contacting my therapist at the address above. (initial) 111. X. Xxxxxxxxx st, Santa Barbara, CA 93101 ❖ Phone (000) 000-0000 ❖ Fax (000) 000-0000 ❖ xxx.xxxxx.xxx
Consent for Treatment means that the client is giving permission to the health care provider to provide medical care and treatment to the client.
Consent for Treatment. I consent to telehealth care performed by my provider and all other associated mental health care providers at 4 Healing Center (4HC) and/or Animals 4 Healing (A4H) (the “Providers”). I understand that I have the option to refuse mental health care services by telehealth at any time without affecting my right to future care or treatment, and without risking the loss or withdrawal of any benefits to which I would otherwise be entitled.
Consent for Treatment. I hereby authorize Xxxxxx Speech Pathology to provide treatment for my child based on IFSP/Physician Treatment Plan until otherwise notified in writing or verbally. Financial Agreement: I hereby authorize Xxxxxx Speech Pathology to bill Medicaid for therapy received for my child. I understand that I will be responsible for any payment/deductible not covered by Medicaid. I understand that I will be held responsible for assuring that my insurance and prescriptions are in good standing at the beginning of every treatment month. I certify that I have read and understand the above and authorize the initialed consent as of the date below. Name of Guardian/Parent Signature Date
Consent for Treatment. I have sought treatment from Teton County Hospital District (including St. John's Medical Center and/or its medical clinics) for one or more medical conditions. Risks of such treatment have been explained to my full satisfaction by St. John’s’ personnel, including my right to refuse any treatment to the extent permitted by law. The results of any treatment cannot be guaranteed. In full knowledge of such risks, I consent to all treatment performed by St. John's and independent providers for the condition(s) for which I have sought treatment within one (1) year of this Agreement, such as routine office visits, diagnostic procedures, and other treatment for such medical condition(s), and all related conditions, in one or more courses of treatment. I accept that I may be asked to sign additional Patient Agreements for specific services such as emergency care, surgery, or inpatient care received within a year of signing this Agreement. I agree to allow students, observers, and the recording of my care for internal use. Financial responsibility: I understand that I am financially responsible for all charges for services provided by St John’s, including any amount not paid by my health care plans.
Consent for Treatment. I authorize the staff of Omni Physical Therapy Services(OmniPT), their employees and consultants to undertake such evaluations treatment, diagnostic procedures and medical procedures, which in their judgment may become necessary while receiving care at OmniPT. I understand that I will be involved and engaged in my care and treatment; and that I have a right to a full explanation of any treatment or procedures utilized. I am aware the practice of medicine is not an exact science and I understand no guarantees have been made to me regarding the results of treatment or examinations. As a patient of OmniPT I understand that individuals being trained in health care may participate in my care. I understand that if I require specialized, emergency care, or care which is out of the scope of practice for OmniPT I will be referred to the appropriate facility and/or providers. I understand that a person listed as my emergency contact will be notified if considered necessary by the professional staff at OmniPT.
Consent for Treatment. I authorize and request my practitioner to carry out exams, treatment, and/or diagnostic procedures, which now, or during the course of my treatment, become advisable. I understand the purpose of these procedures will be explained to me upon my request and that they are subject to my agreement. I also understand that while the course of my treatment is designed to be helpful, my practitioner can make no guarantees about the outcome of my treatment.