- All of our conversations, our work together, your records and any information that you give me are protected by client privilege. That means that the law protects you from having information about you given to anyone without your permission. Your privacy is respected, and I intend to honor your privilege. However, there are some limits to your privilege. Here are some exceptions you should understand before we start.
- If I believe that there is a risk that you might harm yourself or someone else, I may be required to contact the authorities or another person to give them the opportunity to protect you or the other person. If you report the abuse of children or elderly people, I am required by law to notify the authorities, so they can protect others from harm. Also, if you become involved in any lawsuit in which your mental health is an issue, for example, a child custody dispute or an injury lawsuit in which you claim compensation for emotional pain and suffering, the court or the lawyers may insist upon, and may obtain your information from me.
- The financial part of our relationship also imposes some confidentiality limits. If you are using insurance or another third party payer, I must share certain information with them, including (but not necessarily limited to) your diagnosis and the times of your visits. If I submit claims to your managed care company, they may require me to provide additional information such as your symptoms and your progress. You should understand that insurance and managed care information is often stored in national computer databases for an undetermined amount of time.
- As a therapist, I specialize in treating general adult issues. If I believe that your problems require knowledge that I do not have, I may refer you for a consultation with someone with specific training or experience. I will discuss any such referral with you before I act.
- Clients have the right to be treated in a respectful and professional manner. Each client has the right to decline or accept any suggestions or therapeutic strategies as well as the right to be informed of a mental health professional or counselor’s qualifications. In addition, clients have other rights.
- Right to Request Restrictions – clients have the right to request restrictions on certain uses and disclosures of protected health information. However, it is not required that a requested restriction be agreed to.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – Clients have the right to request and receive confidential communications of protected health information (PHI) by alternative means and at alternative locations. (For example, a client may not want a family member to be informed of sessions. On a client’s request, bills may be sent to an alternative address.)
- Right to Inspect and Copy – Clients have the right to inspect or obtain a copy (or both) of PHI in the mental health and billing records used to make decisions about treatment for as long as the PHI is maintained in the record and Progress Notes. Upon request, the details of the request for access process will be discussed with the client.
- Right to Amend – Clients have the right to request an amendment of PHI for as long as the PHI is maintained in the record. This request may be denied. Upon request, the details of the amendment process will be discussed with the client.
- Right to an Accounting – Clients generally have the right to receive an accounting of disclosures of PHI. Upon request, the details of the accounting process will be discussed with the client.
- Right to a Paper Copy – Clients have the right to obtain a paper copy of the notice upon request, even if there has been an agreement to receive the notice electronically.
- Counseling sessions usually last 55 minutes, and we must end each session promptly. Payment is due at the end of your appointment. You will be charged a $100 late cancellation fee if you cannot make your appointment and you do not cancel the appointment 24 hours in advance. Please keep in mind that if you are using insurance they will not cover missed appointments and therefore you will be responsible for the late cancellation fee of $100. If you have missed three consecutive scheduled appointments (without contact or notification), I will accept that as your notice that you wish to terminate this agreement and discontinue counseling with me.
- I check messages throughout the day and whenever possible, I will return the call within the same day. However, if you have an emergency, please call 911 or go to your local emergency room. There may be extended periods of time when I will be unreachable due to travel. During that time I may give you the number of another counseling professional to assist in my absence.
- This information is to help you understand some things about counseling and what you can expect from our time together. If you have any questions or concerns before we begin or at any time, please don’t hesitate to ask so that I can explain more fully.