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WWW.ANLCI.fieldstone Park 11105 NE 14th Street, Suite 103 Vancouver, WA 98684 Email: jeff4counseling@gmail.com Phone: (360) 8361872 PROFESSIONAL DISCLOSURE STATEMENT FOR Jeffrey ShenkWelcome! Before
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Start by gathering all the necessary information and documentation required for filling out the Alex disclosure statement telehealth.
02
Begin by providing your personal details such as name, contact information, and any relevant identification numbers.
03
Next, carefully review the disclosure statement form, ensuring that you understand all the terms and conditions mentioned.
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Fill in the necessary sections of the form, providing accurate and truthful information. Pay close attention to any specific instructions or requirements.
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If there are any additional attachments or supporting documents required, make sure to attach them securely to the disclosure statement.
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Submit the completed form and any additional attachments according to the instructions given.
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Keep a copy of the filled-out disclosure statement for your records.
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If there are any updates or changes in your disclosures, make sure to promptly inform the relevant authorities and update the disclosure statement accordingly.

Who needs alex disclosure statement telehealth?

01
Anyone engaging in telehealth services through Alex may need to fill out the Alex disclosure statement telehealth.
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This includes both healthcare providers and patients who participate in telehealth consultations or services.
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The disclosure statement is important for ensuring that both parties have a clear understanding of the terms, responsibilities, and potential risks associated with telehealth.
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The Alex Disclosure Statement for Telehealth is a document that outlines the nature, benefits, and risks associated with telehealth services provided to patients.
Healthcare providers offering telehealth services are typically required to file the Alex Disclosure Statement.
To fill out the Alex Disclosure Statement for Telehealth, providers must provide specific information regarding the services offered, any technology used, and obtain patient consent.
The purpose of the Alex Disclosure Statement for Telehealth is to ensure transparency by informing patients about the telehealth services being provided, and to facilitate informed consent.
The information reported on the Alex Disclosure Statement includes details about the provider’s qualifications, service descriptions, potential risks, and patient rights and responsibilities.
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