PRACTICE POLICY AND PROCEDURES


POLICY AND PROCEDURE GUIDELINES 

   - We strictly adhere to all applicable laws and regulations regarding client confidentiality, including compliance with HIPAA regulations.
   - All client information, records, and communication are treated with the utmost confidentiality and stored securely.
   - Confidentiality limitations are followed by Hippa guidelines.

2. Informed Consent:
  
   - Informed consent will be obtained and documented prior to the commencement of treatment on your first intake day.


3. Appointment Scheduling:
   - Our practice operates by appointment only.
   - Appointments can be scheduled by contacting our office via phone or email.
   - We strive to accommodate your preferred appointment time; however, availability may vary.


4. Fees, Payment, and Insurance:
   - Our fee structure will be clearly communicated to clients during the initial contact and consultation.
   - Accepted payment methods will be discussed and arrangements made prior to services being rendered.
   - We will provide a superbill or assist with insurance claim forms if clients wish to seek reimbursement from their insurance providers.


5. Cancellation and No-Show Policy:
   - We kindly request 24 hours' notice for cancellations or rescheduling of appointments.
   - Late cancellations or no-shows may result in $100.00 no show fee.
   - Exceptions may be made for emergencies and extenuating circumstances, which will be discussed on an individual basis.


6. Professional Boundaries:
   - In order to maintain professional boundaries and adhere to ethical guidelines to ensure the integrity of the therapeutic relationship, patients may have to be discharged if boundaries have been crossed due to conflict of interest or other reasons.
  

7. Complaints and Grievances:
   - We take client feedback seriously and have a procedure in place to address any concerns or complaints.
   - Clients are encouraged to communicate any grievances promptly, and we will work to resolve them in a timely and professional manner.


8. Emergency Situations and Crisis Management:
   - In the event of an emergency or crisis situation, please contact emergency services or your designated emergency contact.
   - If you need immediate support, call your local emergency hotline or the National Suicide Prevention Lifeline .


Please note that these policies and procedures are subject to change, and the most up-to-date version will always be available on our website. By choosing to engage in our mental health services, you agree to abide by these policies and procedures.


If you have any questions or concerns regarding these policies, please do not hesitate to reach out to us. We are here to provide the best possible care and support for your mental health needs.

NEW PATIENT EVALUATION

NEW PATIENT EVALUATION DOES NOT GUARANTEE FUTURE CARE. WE TRY OUR BEST TO MAKE THIS DETERMINATION DURING YOUR FIRST PHONE CALL BUT AT TIMES CERTAIN INFORMATION IS NOT RELAYED TO THE INTAKE COORDINATOR.

 IN THE EVENT YOU ARE NOT A GOOD FIT TO BE A PATIENT OF THIS PRACTICE WE WILL EXPLAIN THE REASON/REASONS, BUT YOU ARE STILL RESPONSIBLE FOR PAYMENT.

 MEDICATION REFILLS

1. Refills will not be provided when the office is closed,/outside office hours or weekends and holidays. During these hours, patients must call their PCP or go to the emergency room to avoid medication discontinuation and withdrawal effects.

2. Patients are responsible for knowing when medications will need to be refilled and the required method is to ask the provider during scheduled office visits.

3. Same day or walk-in refill requests will not be honored unless patients have an appointment scheduled with their provider. Providers need to be able to have access to patient's charts in order to safely prescribe.

4. If a patient has not been evaluated in 3 months, it is our policy to discharge the patient. Letters or discharge summary will not be sent unless requested in writing due to confidentiality reasons.

5. There are strict guidelines for controlled substances including medications for ADHD and anxiety. These will not be called for refills. The patient must be evaluated even if prescription was lost or expired. 

 

 Emergencies

In the event of an urgent situation or an emergency and your provider is not available to return your call, please don't wait for a phone call back. Call 911 or go to your nearest Emergency Room.

You may also call the national Suicide Prevention Lifeline at 1-800-273-8255 .

If you are a patient who requires frequent crisis management, or has a history of requiring this, you may be better served by a more comprehensive service agency that can better address these ongoing issues. In the event that you are a patient of this practice, we will discuss the issue with you and provide some referrals so you can be better served according to your level of care.

 Provider Absence/Weather Emergencies

In the event your provider will be absent for your appointment, the office will notify the patient and arrangements will be made in regards to any treatment or medication refills. In the these arrangements require another provider to provide covering services, that provider or office staff will have access to your confidential medical or mental health information during this time.

 

 Email and Text Communication 

If you choose to email the practice and/or a staff member from your personal email account or by text, please limit the contents to issues such as cancellation or change in appointment time. Email and text messages are not guaranteed confidentiality. If you choose to communicate with us this way, you do so understanding that we cannot guarantee that these modes of communication are confidential. 

 

   Limitation of Services

   These services are not provided in this practice:           

  1. Custody evaluations, parental assessments for use in determining custody or visitation.
  2. Forensic evaluations for legal services.
  3. Court appearances
  4. Substance Abuse Treatment
  5. Disability Evaluations, including Short Term Disability and determining leave of absences from  work.

 It's up to the discretion of our providers to determine if those services will be provided.

 

Cancellations, Missed Appointments, and/or No-Shows

If you cannot attend your appointment you must notify the office at least 24 hours in advance to avoid being charged a $100 cancellation fee. This fee needs to be paid prior to rescheduling your appointment.

Medication refill requests may not be honored if the patient has missed or cancelled one or more appointments. 


Policy and Procedure for Requesting Mental Health Records in Compliance with HIPAA Guidelines

We prioritize the confidentiality and privacy of our clients' mental health records. To facilitate the release of these records in compliance with the Health Insurance Portability and Accountability Act (HIPAA) guidelines, we have established the following policy and procedure:


Policy:


1. Purpose:
   - The purpose of this policy is to outline the process for clients or their authorized representatives to request access to their mental health records.


2. Compliance with HIPAA:
   - All releases of mental health records will comply with the privacy and security provisions outlined in HIPAA, including the applicable State regulations, if any.


3. Client Rights:
   - Clients have the right to access and obtain copies of their mental health records, except when restricted by law. This policy ensures that their rights are respected and protected.


4. Confidentiality:
   - All mental health records will be handled in a manner that maintains strict confidentiality, complying with HIPAA requirements to safeguard client privacy.


Procedure:


1. Requesting Mental Health Records:
   - To request access to mental health records, clients or authorized representatives must submit a written request in person or obtaining our online form via our website, fill out the form and send with your signature.
   - The request should include the client's full name, date of birth, contact information, the specific dates or timeframe of the records requested, and the purpose for which the records are being requested. Records are only kept for seven years as required by law.
   - If the request is made by an authorized representative, written proof of authorization (e.g., power of attorney, legal guardianship)and a notarized signature must accompany the request.


2. Verification of Identity:
   - To ensure the protection of client privacy, we require  authorized representatives to provide a valid form of identification (e.g., driver's license, passport) along with their request. This allows us to confirm the identity of the person requesting the records.


3. Processing Time:
   - We strive to process record requests promptly and within the timelines specified by HIPAA.
   - Within 30 days of receiving a complete and valid request, we will either provide the requested records or inform the client of any extenuating circumstances that may cause a delay. In such cases, an alternative timeline will be communicated.


4. Fees for Record Requests:
   - A reasonable fee may apply for the preparation, handling, and mailing of requested records, in accordance with HIPAA guidelines and applicable state regulations.
   - Clients will be informed of any fees prior to fulfilling the record request, and payment arrangements will be made in advance.


5. Denial of Requests:
   - In certain cases, HIPAA may allow for the denial of a record request if it presents a risk to the client's or another person's health or safety, or if it infringes upon the privacy rights of another individual or poses the client at any risk for domestic violence. In certain circumstances when the patient/client lives with another person in the household, certain facts may be redacted or parts of the record may not be sent to make sure the safety of the client/patient.  
  

6. Record Amendment or Correction:
   - If a client identifies incorrect or incomplete information in their mental health records, they may request an amendment or correction.
   - Clients must submit a written request specifying the information to be amended or corrected, along with any supporting documentation.
   - We will review the request within 60 days and notify the client of the decision, including any changes that were made or the reasons for denial.

Does HIPAA provide extra protections for mental health information compared with other health information?

Generally, the Privacy Rule applies uniformly to all protected health information, without regard to the type of information. One exception to this general rule is for psychotherapy notes, which receive special protections. The Privacy Rule defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record. See 45 CFR 164.501.

Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive information and because they are the personal notes of the therapist and  are not required or useful for treatment, payment, or health care operations purposes, other than by the mental health professional who created the notes. A notable exception exists for disclosures required by other law, such as for mandatory reporting of abuse, and mandatory “duty to warn” situations regarding threats of serious and imminent harm made by the patient.

Psychotherapy notes are primarily for personal use by the treating professional and generally are not disclosed for other purposes. Thus, the Privacy Rule includes an exception to an individual's (or personal representative's) right of access for psychotherapy notes. See 45 CFR 164.524(a)(1)(i).


Please note that this policy and procedure may be subject to change in accordance with updates in HIPAA regulations and other applicable laws. The most current version will be available on our website.


If you have any questions or require assistance regarding the request for mental health records, please contact our office for further guidance.

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