I UNDERSTAND AND AGREE THAT ANYTIME I AGREE AND ACKNOWLEDGE ANYTHING THROUGH THERAP I AM SUBMITTING A LEGALLY BINDING E-SIGNATURE THROUGH MY SECURE ACCOUNT THAT ONLY I CAN ACCESS THAT RECORDS AND TIMESTAMPS MY SIGNATURE.
I will be committed to knowing and understanding all policies and procedures, rules and regulations, contract and agreements. I will review policies and procedures if needed and ask questions if I don't understand. I can find the most updated policies and procedures here:
I attest that the documentation made provided in each record accurately reflect the services provided, diagnosis, treatments, and information as recorded during this session. The electronic health record does accurately reflect my role, relationship, position and intent as indicated by my name, title and capacity for the record.
I attest that this information is true, accurate, and complete to the best of my knowledge. I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. I agree and understand that these statements are being made under penalty of perjury.
I commit to making sure that my notes will reflect the rules and regulations regarding search service type. If the information I provide does meet requirements or if later a claim is revoked due to inadequate notes then the agent is responsible for repayment for any funds that I have received. By working with any client I attest that I have read all available information in their file as there file functions as each client's person specific training.
Furthermore, by accepting a client I attest that my expertise matches the clients needs and that I am a competent provider for that person's specific needs. If I’m not then I will decline working with client or create a client/family action plan on what needs to take place in order for there to be a client need / provider skill match. I commit that all information providing is true and accurate to my knowledge. If at ANY TIME, any information on my part changes that would possibility violate this agreement I must stop seeing clients right away, contact ANGELS and determine an appropriate action plan. Examples would be, if I had a law suit filed against me, have been accused of a crime, my insurance or license lapsed, etc. (this in not an all-inclusive list). If any of my contact information or credentials needs to be updated I will contact Angels Service LLC immediately.
Applies to contract holders only:
If at any time contract is out of compliance, there are penalties up to forfeiture of pay. If IC is eligible as a volunteer then IC will default to volunteer status if contractor wishes to continue to provide services outside of the IC realm while the out of compliance procedure is followed. Data is due at the time of service with verification from family / client. Delay in data may result in fees, delayed reimbursement, or no reimbursement depending on funding sources and applicable regulations.