Practice Policies
Confidentiality
I will treat with great care all the information you
share with me. It is your legal right that our sessions
and my records be kept private. That is why I ask
you to sign a “release of information/records”
form before I can talk about you or your case with
anyone or send records to anyone. In general, I will
tell no one what you tell me. I will not even reveal
that you are receiving treatment from me. As a practice,
should I meet you in a social setting outside of the
office, I will not acknowledge that I know you unless
you acknowledge me first. Should you elect to file
for insurance reimbursement, please be aware that
your insurance company may require specific clinical
information which may be private in nature before
they will agree to pay for your claim. Once information
is processed with the billing and insurance companies,
I do not have control over how this information
is utilized or by whom. Any information processed
via fax or through electronic means by my office,
billing agent, or answering service will be processed
according to HIPPA guidelines. All of our employees
have been asked to sign a confidentiality statement.
Violation of the confidentiality policy will result
in automatic dismissal. In all but a few rare situations,
your confidentiality (that is your privacy) is protected
by state and federal law and by the code of ethics
of my profession. Here are the most common cases in
which confidentiality is NOT protected.
1.If you were sent to me by a court
for evaluation or treatment, the court expects a report
from me. If this is your situation, please talk with
me before you tell me anything you do not want the
court to know. You have a right to tell me only what
you are comfortable in telling me and information
you would not mind being heard before the court.
2. Are you suing someone or being sued?
Are you being charged with a crime? If so, and you
tell the court that you are seeing me, I may then
be ordered to show the court my records. Please consult
your attorney about these issues.
3. If you make a serious threat of harm
to yourself or another person, the law requires me
to try and protect you or that other person. This
usually means telling others about the threat and
your plans. The police will be notified in both cases.
I CANNOT promise never to tell others about
threats you make.
4. If I believe or suspect that a child
has been or will be abused or neglected, I am legally
mandated to report this to the authorities. This includes
information received by or from your child(ren) regarding
abuse. This includes a report being filed to the Department
of Children’s Services in the State wherein the
child resides or with the legal authorities as is
indicated by State law. In cases of incest, even between
siblings, a report must be filed for
sexual abuse. There are NO exceptions regarding
this law.!!!!
5. When a client is referred by a physician
or other professional, communication regarding pertinent
treatment considerations will be maintained with that
professional unless the client specifies to the contrary.
This statement means that a call will be placed or
a note will be sent to the referring professional
to thank them for their referral and to coordinate
ongoing treatment where the client is concerned. You
will be asked to sign a release of
information regarding the release of specific clinical
information.
6. If I am contacted by your attorney
regarding treatment, any correspondence beyond acknowledging
dates of service will be subject to being billed on
an hourly basis for report preparation. This is NOT
covered by your insurance and payment must be received
prior to the release of the report. These services
are billed at a rate of $175 per hour on a quarter
hour basis for all verbal and written forms of communication.
7. Confidentiality regarding the
treatment of minors (persons below the age of 18 who
do not live independently and remain under the legal
responsibility of their parents or legal guardian:
Respect will be given to children and adolescents
regarding their request that specific information
not be shared with their parent. However, involvement
of parents or legal guardians is required any time
I see a child or adolescent for therapy. Information
regarding the family will be openly exchanged among
all persons involved. Adolescents involved in individual
therapy and parents must both agree to trust that
the therapist will only disclose information which
is pertinent to the therapeutic outcome of their therapy
session. In addition, adolescents disclosing information
pertinent to a crime, self-harm or possible injury/threat
to others will be reported to proper legal authorities
and to their legal guardian. Disclosure of physical,
sexual, emotional abuse and/or neglect will be reported
to the appropriate legal authorities. Please be advised
that it is suggested that all adolescents be tested
for the presence of illegal drugs prior to being seen
for therapy. We can provide urine testing through
our office or you may contact your primary
care physician. There is a lab charge for specimens
in our office and it must be paid for at the time
the specimen is collected. We do not bill insurance
for lab. In accordance with state law, 16 years olds
have the right to choose or refuse treatment with
the same guidelines being extended to them as if they
were an adult seeking voluntary treatment.
8. Legal guardianship must be documented
in cases of treatment for non-biological children.
A copy must be included in your file.
9. Joint parenting (custody) situations
as a result of divorce require a copy of your Parenting
Plan to be on file in the child’s record. It
is the responsibility of the parent initiating treatment
to provide the therapist with a copy by the second
scheduled visit. Both parents have access to the information
regarding the treatment of a child or adolescent in
a joint situation. One parent may consent to treatment
but a statement from the other is required
to be included in the file indicating that the other
parent is aware of treatment. It is the admitting
parent’s responsibility to furnish this documentation
if requested by the therapist. You are responsible
for obtaining a notarized note from the other parent
unless both are participating in the therapy process.
It is also the responsibility of the parent
consenting to treatment to ensure payment for the
services even if they are to be paid by another’s
insurance due to divorce. The consenting parent
must present updated insurance information of their
ex-spouse if the child is covered under their policy.
Otherwise, the consenting parent will assume TOTAL
FINANCIAL RESPONSIBILITY for the services provided.
Parents should also be aware that family sessions
will generally not be held separately in join parenting
situations. It is the parents responsibility to be
present at scheduled sessions and the former spouse’s
responsibility to coordinate the sessions with the
therapist and their ex-spouse. It is not the responsibility
of the therapist or the therapist’s staff to
notify ex-spouses of treatment appointment times.
10. Sole parenting (custody) situations
as a result of divorce. A copy of your divorce/guardianship
papers should be provided by you to be included in
your file if requested by the therapist. Only the
legal guardian will be involved in the therapeutic
process or be given information pertaining to the
case without the proper releases of information. If
you want the other biological parent or any other
individual involved in the treatment process, a release
of information must be completed to include that parent/guardian/family
member before they will be allowed to participate
or before any information is released to them. It
is the responsibility of the parent to provide telephone
numbers where they may be easily contacted or it is
their responsibility to call the therapist.
