This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment and health care operations.
EFFECTIVE DATE: JANUARY 15, 2016
Confidentiality and Therapy
Your counselor will make every effort to keep your personal information private. If you wish to have information released, you will be required to sign a consent form before such information will be released. There are some limitations to confidentiality to which you need to be aware. Your counselor may consult with a supervisor or other professional counselor in order to give you the best service. In the event that your counselor consults with another counselor, no identifying information such as your name would be released. Counselors are required by law to release information when the client poses a risk to themselves or others and in cases of abuse to children or the elderly. If your counselor receives a court order or subpoena, she may be required to release some information. In such a case, your counselor will consult with other professionals and limit the release to only what is necessary by law.
Confidentiality and Group Therapy
The nature of group counseling makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that your counselor cannot guarantee that other group members will maintain your confidentiality. However, your counselor will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. Your counselor also has the right to remove any group member from the group should she discover that a group member has violated the confidentiality rule.
Confidentiality and Technology
Some clients may choose to use technology in their counseling sessions. This includes but is not limited to online counseling via Skype, telephone, email, text or chat. Due to the nature of online counseling, there is always the possibility that unauthorized persons may attempt to discover your personal information. Your counselor will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your counseling sessions.
Confidentiality and Social Media
In protecting the confidential nature of your protected health information (PHI) e.g. your identity, etc, please do not post or comment on social media platforms regarding your therapeutic relationship with me. It is not secure nor safe because your confidentiality could be compromised. Also, communications using a social media platform could possibly be documented and collected to be placed in your mental health record. The best way to contact me in regards to the therapeutic relationship or therapeutic services is by phone (857.728.4929) or by email ([email protected]). Depending on the route you choose, I am unable to follow you on any social media platform due to the continuous quality of care for the provision of safe, secure and confidential therapeutic services.
Your counselor may keep records of your counseling sessions and a treatment plan which includes goals for your counseling. These records are kept to ensure a direction to your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality and therapy section. Should the client wish to have their records released, they are required to sign a release of information which specifies what information is to be released and to whom. Records will be kept for at least 7 years but may be kept for longer. Records will be kept either electronically on a USB flash drive or in a paper file and stored in a locked cabinet in the counselor's office.
Confidentiality and Insurance
For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization. For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection. If we are not in-network with your insurance company, you may choose to bill your own insurance company. If you decide to bill your insurance company, your protected health information (PHI) will be required by your health insurance company in order to process claim forms. If you require that we communicate your PHI to your health insurance company, the minimum requirement of your PHI that is needed by your health insurance company will be disclosed.
Changes to the Terms of this Notice. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. If you have any questions about these policies and rights, please contact us using the information below.
Cancellation Policy (Face-to-face/Group Therapy Sessions and E-Therapy/Online Services)
Your scheduled appointment secures that time for you and your therapist. The expectation is that you will make every effort to keep and honor your appointment. At the same time, it is understood there are times when appointments need to be cancelled and/or rescheduled. For those times, this Cancellation Policy will be honored:
Cancellation Policy - Fees will be charged for missed appointments or no show cancellations with less than a 48 hour notice.
Only one service may be purchased at a time, which allows the client to choose how often to engage in face-to-face/group/Online-E-therapy sessions. If your scheduled time slot for sessions does not work for you, you will always have the option to reschedule a service already purchased without penalty if you contact Dr. Holder 48 hours before the session time. If you are late to your scheduled time, you will receive your service for the remainder of your scheduled session time slot, without refund. If you do not show up or answer your phone for a scheduled session at all, nor do you contact Dr. Holder to reschedule, this is considered a "no show", you will not be allowed to reschedule your session. Once a service is purchased and the session time missed, there are no refunds.
Additional Terms & Conditions
Based on the communication from face-to-face and/or telehealth (e-therapy) mental health services, clients are 100% responsible for their personal lifestyle changes and relationships with others. Face-to-face and/or telehealth (e-therapy) sessions with Dr. Holder are in no way meant to replace mental health treatment, medical, or legal advice. All recommendations/suggestions are meant to help clients gain insight into their personal life choices and make their own decisions with future behaviors.
CONSENT TO COUNSELING/TELEHEALTH THERAPY SERVICES