The information you share in my office is confidential with some exceptions listed in the Notice of Privacy Practices. A Consent for Treatment must be signed prior to receiving services stating you have read and understood the privacy notice and this letter and are informed of your rights and how information can be used and disclosed. If you have signed an authorization to release specific information with another resource, in some instances I may want to call you to discuss what I will be releasing before your records are released. If your case requires consultation with other professionals your identity will be protected or in the case of providers involved in your treatment an authorization will be requested before a consultation takes place.
Information is requested by insurance companies for the purpose of payment and medical necessity when they cover a portion of the cost of psychotherapy. Most commonly they request diagnoses, symptoms, and treatment plans to determine if your symptoms and treatment meet their criteria for payment. The Consent for Treatment form allows me to share this information with your insurance company for treatment, payment and business operations purposes.
Audio and video recording will not be permitted without your written consent. E-mails are not considered private and will be used only for scheduling or billing at your request.
Client Rights and Responsibilities and the Grievance Procedure are in the waiting room for your review. A long version of the Notice of Privacy Practices with more detailed information is on the desk in the waiting room for further information. Please ask questions and express any concerns you may have prior to signing the Consent for Treatment form.