Common use of CONTACTING ME Clause in Contracts

CONTACTING ME. Due to the nature of the work, texting is the easiest method to contact. Every effort will be made to return your call within 12 hours, with the exception of weekends and holidays. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room. If we will be unavailable for an extended time, we will let you know 2-12 months in advance unless it is an emergency. Sessions are between $240-$350 per session (and this fee goes up $20 for individual and $50 for couples each January) depending on the type of session. In addition to weekly appointments, I charge the cost of your session fee for other professional services, although I will break down the hourly cost if we worked for periods of less than one hour. Other services include report writing, telephone conversations lasting longer than 5 minutes, consulting with other professionals at your request, preparation of records or treatment summaries, and time spent performing any other service you may request. If you become involved in legal proceedings that require my participation in the form of paperwork my feel is $500 per hour. I do not participate in any court matters. You will be expected to pay weekly or monthly for sessions depending on what is agreed. Payment schedules for other professional services will be agreed to when requested. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I maintain the option of using legal means to secure the payment. This may involve hiring a collection agency, which will require the disclosure of otherwise confidential information. In most collection situations, the only information released regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due. If such legal action is necessary, the costs will be included in the claim. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of fees. It is important that you determine exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator.

CONTACTING ME. Due If you choose to the nature of the workcommunicate with me by email, texting you are advised to limit your messages to logistical matters such as scheduling appointments and I will respond to you accordingly. However, communicating with me by email is the easiest method not recommended because emailing is not secure and confidentiality may be breached. Also, my response time by email is likely to contactbe slower. Every When I am not immediately available by phone my voice mail will take messages. I will make every effort will be made to return your call within 12 hourson the same day you make it, with the exception except for evenings, weekends, holidays and vacations. In case of weekends a clinical emergency, if you do not hear back from me promptly, and holidays. If you feel you are unable facing a life-threatening situation, always call 911 or go to reach a nearby hospital emergency department. Therapy sessions generally run about 45 minutes, leaving me the remainder of the appointment hour to complete paperwork and feel any necessary phone calls regarding our work together. My standard hourly fee for psychological services is $140 for each visit, unless you request that you cannot wait for me your fee be set according to return your calla sliding scale, contact based on factors such as your family physician or income and the nearest emergency roomnumber of people supported by this income. If we will Please note that if you are using insurance your co-payment and the payments I receive from your insurance company are determined by your insurance plan and may be unavailable for an extended time, we will let you know 2-12 months different than the fees set out in advance unless it is an emergencythis agreement. Sessions are between $240-$350 per session (and this fee goes up $20 for individual and $50 for couples each January) depending on the type of session. In addition to Besides weekly appointments, I charge the cost of your session my standard hourly fee for other professional servicesservices you may need, although though I will break down the hourly cost if we worked I work for periods of less than one hour. Other services include report writing, telephone phone conversations lasting longer than 5 minutes, consulting consultations with other professionals at with your requestpermission, preparation of records or treatment summaries, and the time spent performing any other service you may requestrequest of me. If you become involved in legal proceedings that require my participation participation, you will be expected to pay for all of my professional time and transportation costs, even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $300 an hour for my professional time spent in the form of paperwork my feel is $500 per hour. consultations with attorneys, report writing, preparation and attendance at any legal proceeding and any other duties I do not participate in any court perform relating to such legal matters. You will be expected to pay weekly for each session by cash or monthly for sessions depending on what check at the time it is agreedheld. Payment schedules for other professional services Unless we agree otherwise or unless you have insurance coverage that requires another arrangement, fees not paid at the time of the visit will be agreed subject to when requesteda late penalty fee of $10. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed uponOnce an appointment hour is scheduled, I maintain the option of using legal means to secure the payment. This may involve hiring a collection agency, which will require the disclosure of otherwise confidential information. In most collection situations, the only information released regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due. If such legal action is necessary, the costs you will be included in expected to pay for it unless you provide at least 24 hours notice of cancellation. Insurance companies do not provide reimbursement for cancelled sessions. Missed appointments are charged at the claimfull session rate. If you have a health insurance policy, it will usually provide some coverage for mental health treatmentAppointments cancelled or rescheduled within 24 hours are billed at half the hourly fee. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of feesTHIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. It is important that you determine exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administratorPLEASE REVIEW IT CAREFULLY.

CONTACTING ME. Due to the nature of the workDuring workdays, texting my telephone is the easiest method to contactanswered by my office manager or voice mail that I monitor frequently. Every I will make every effort will be made to return your call within 12 24 hours, with the exception of weekends and holidays. During weekends or holidays, I will return your call on the next business day. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you cannot can’t wait for me to return your call, contact your family physician or physician, go to the nearest emergency room, or dial 9-1-1. If we I will be unavailable for an extended time, we I will let provide you know 2-12 months in advance unless it is an emergencywith the name of a colleague to contact, if necessary. Sessions are The law protects the privacy of all communications between $240-$350 per session (a patient and this fee goes up $20 for individual and $50 for couples each January) depending on the type of sessiona psychologist. In addition to weekly appointmentsmost situations, I charge can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the cost identity of your session fee for other professional services, although I will break down the hourly cost if we worked for periods of less than one hourmy patient. Other services include report writing, telephone conversations lasting longer than 5 minutes, consulting with The other professionals at your request, preparation of records or treatment summaries, and time spent performing any other service you may requestare also legally bound to keep the information confidential. If you become involved in legal proceedings don’t object, I will not tell you about these consultations unless I feel that require my participation in the form of paperwork my feel it is $500 per hourimportant to our work together. I do will note all consultations in your Clinical Record (which is called “PHI” in my Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information). Disclosures required by health insurers or to collect overdue fees are discussed elsewhere in this Agreement. The laws governing confidentiality can be quite complex, and I am not participate in any court mattersan attorney. In situations where specific advice is required, formal legal advice may be needed. You will should be expected aware that, pursuant to pay weekly or monthly for sessions depending on what is agreed. Payment schedules for other professional services will be agreed to when requested. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed uponHIPAA, I maintain keep Protected Health Information about you in two sets of professional records. One set constitutes your Clinical Record. It includes information about your reasons for seeking therapy, a description of the option of using legal means to secure the payment. This may involve hiring a collection agencyways in which your problem impacts on your life, which will require the disclosure of otherwise confidential information. In most collection situationsyour diagnosis, the only information released regarding a patient’s goals that we set for treatment, your progress towards those goals, your medical and social history, your treatment is his/her namehistory, the nature any past treatment records that I receive from other providers, reports of services providedany professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier. Except in unusual circumstances that involve danger to yourself and others or where information has been supplied to me confidentially by others, you may examine and/or receive a copy of your Clinical Record, if you request it in writing. I believe that trust is the amount duecornerstone of a positive therapeutic relationship. If such legal action is necessaryReading the Clinical Record can sometimes lead to unnecessary misunderstandings that can undermine the therapeutic process. Therefore, I strongly discourage the costs will be included direct releast of notes to an individual in the claim. If you have a health insurance policy, it will usually provide some coverage for mental health active treatment. I will fill out forms gladly forward your Clinical Record to another clinician or legal representative. If I refuse your request for access to your records, you have a right of review, which I will discuss with you upon request. In addition, I also keep a set of Psychotherapy Notes. These Notes are for my own use and provide are designed to assist me in providing you with whatever assistance I the best treatment. While the contents of Psychotherapy Notes vary from client to client, they can in helping you receive include the benefits to which you are entitled; howevercontents of our conversations, you (not my analysis of those conversations, and how they impact on your insurance company) are responsible for full payment of feestherapy. It is important They also contain particularly sensitive information that you determine exactly what mental health services your insurance policy covers. You should carefully read the section may reveal to me that is not required to be included in your Clinical Record. They can also include information from others provided to me confidentially. These Psychotherapy Notes are kept separate from your Clinical Record. Your Psychotherapy Notes are not available to you and cannot be sent to anyone else, including insurance companies without your written, signed Authorization. Insurance companies cannot require your authorization as a condition of coverage booklet that describes mental health services. If nor penalize you have questions about the coverage, call in any way for your plan administratorrefusal to provide it.

CONTACTING ME. Due to my work schedule, I am often not immediately available by telephone. My phone is answered by voice mail when I am unavailable, however, it is often difficult to check messages until the nature end of the workday. If you leave a message, texting is the easiest method I will make every effort to contactrespond in a timely manner, usually within 24 hours, except for weekends and holidays. Every effort will Telephone contact should be made limited to cancelling, rescheduling, and confirming appointments, obtaining directions, or other pertinent information. In such cases, I may return your call within 12 hoursthe next business day. In the rare emergency where we have an extended phone conversation over 15 minutes, with the exception you will be charged a pro-rated amount of weekends and holidaysmy hourly fee. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and you feel that you cannot wait for me to return your callcall or it is a life threatening emergency, please call 911 and/or contact your family physician or the nearest emergency room. Please then contact me at your earliest possible convenience. If we I will be unavailable for an extended time, we I will let provide you know 2-12 months in advance unless it is an emergencywith the name of a colleague to contact, if necessary. Sessions are The law protects the privacy of all communications between $240-$350 per session (a client and this fee goes up $20 for individual a Licensed Marriage and $50 for couples each January) depending on the type of sessionFamily Therapist. In addition to weekly appointmentsmost situations, I charge can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. However, there are some situations where I am permitted or required to disclose information without either your consent or Authorization:  I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the cost identity of your session fee for other professional services, although I will break down the hourly cost if we worked for periods of less than one hourmy patient. Other services include report writing, telephone conversations lasting longer than 5 minutes, consulting with The other professionals at your request, preparation of records or treatment summaries, and time spent performing any other service you may requestare also legally bound to keep the information confidential. If you become do not object, I will not tell you about these consultations unless I feel that it is important to our work together. I will note all consultations in your Clinical Record.  Although I share office space with other health professionals in this office, I am completely independent in providing you with clinical services and I alone am fully responsible for those services.  If you threaten to harm yourself, I may be obligated to seek hospitalization for you, or to contact your family members or others who can help provide protection.  If you are involved in a court proceeding and a request is made for information about the professional services that I have provided you and/or the records thereof, such information is protected by psychotherapist-patient privilege law. I cannot provide any information without your (or your legally-appointed representative’s) written authorization, a court order, or compulsory process (a subpoena) or discovery request from another party to the court proceeding where that party has given you proper notice (when required), has stated valid legal proceedings that require my participation in the form of paperwork my feel is $500 per hour. grounds for obtaining PHI, and I do not participate have grounds for objecting under state law (or you have instructed me not to object). If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information.  If a government agency is requesting the information for health oversight activities pursuant to their legal authority, I may be required to provide it for them.  If you file a complaint or lawsuit against me, I may disclose relevant information regarding you in order to defend myself.  If you file a worker’s compensation claim, I must, upon appropriate request, disclose information relevant to your condition, to the worker’s compensation insurer.  There are some situations in which I am legally obligated to take actions that which I believe are necessary to attempt to protect others from harm. In such situations, I may have to reveal some information about your treatment. These situations are unusual in my practice. They include the following:  If I have knowledge of a child under 18 or I reasonably suspect that a child under 18 that I have observed has been the victim of child abuse or neglect, the law requires that I file a report with the appropriate governmental agency, usually the county welfare department. I also may make a report if I know or reasonably suspect that mental suffering has been inflicted upon a child or that his or her emotional well- being is endangered in any court mattersother way (other than physical or sexual abuse, or neglect). You Once such a report is filed, I may be required to provide additional information.  If I observe or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if an elder or dependent adult credibly reports that he or she has experienced behavior including an act or omission constituting physical abuse, abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, the law requires that I report to the appropriate government agency. Once such a report is filed, I may be required to provide additional information.  If you communicate a serious threat of physical violence against an identifiable victim, I must take protective actions, including notifying the potential victim and contacting the police. I may also seek hospitalization for you, or contact others who can assist in protecting the victim. I am also required to take such protective actions described above if your family informs me that you communicated a serious threat of physical violence against an identifiable victim.  If I have reasonable cause to believe that you are in such mental or emotional condition as to be dangerous to yourself, I may be obligated to take protective action, including seeking hospitalization or contacting family members or others who can help provide protection. If such a situation arises, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws governing confidentiality can be quite complex, and I am not an attorney. In situations where specific advice is required, formal legal advice may be needed. The laws and standards of my profession require that I keep Protected Health Information (PHI) about you in your Clinical Record. It includes information about your reasons for seeking therapy, a description of the ways in which your problem impacts your life, your diagnosis, the goals that we set for treatment, your progress towards those goals, your medical and social history, your treatment history, any past treatment records that I receive from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier. Except in unusual circumstances that disclosure would physically endanger you and/or others or makes reference to another person (unless such other person is a health care provider) and I believe that access is reasonably likely to cause substantial harm to such other person or where information has been supplied to me confidentially by others, you may examine and/or receive a copy of your Clinical Record, if you request it in writing. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. For this reason, I recommend that you initially review them in my presence, or have them forwarded to another mental health professional so you can discuss the contents. There will be expected a copying fee of 35 cents per page. If I refuse your request for access to pay weekly your records, you have a right of review, (except for information supplied to me confidentially by others) which I will discuss with you upon request. Though at this time I am not a HIPPA covered provider, in the future should I become one, HIPAA provides you with several new or monthly for sessions depending expanded rights with regard to your Clinical Records and disclosures of protected health information. These rights include requesting that I amend your record; requesting restrictions on what information from your Clinical Records is agreeddisclosed to others; requesting an accounting of most disclosures of protected health information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about my policies and procedures recorded in your records; and the right to a paper copy of this Agreement. Payment schedules for other Patients under 18 years of age who are not emancipated can consent to psychological services subject to the involvement of their parents or guardian unless the therapist determines that their involvement would be inappropriate. A patient over age 12 may consent to psychological services if he or she is mature enough to participate intelligently in such services, and the minor patient either would present a danger of serious physical or mental harm to him or herself or others, or is the alleged victim of incest or child abuse. In addition, patients over age 12 may consent to alcohol and drug treatment in some circumstances. However, un-emancipated patients under 18 years of age and their parents should be aware that the law may allow parents to examine their child’s treatment records unless I determine that access would have a detrimental effect on my professional services will be agreed relationship with the patient, or to when requestedhis/her physical safety or psychological well- being. If your account has not been paid for more than 60 days Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, and arrangements for payment have not been agreed uponparental involvement, is also essential, it is usually my policy to request an agreement with minors (over age 12) and their parents about access to information. This agreement provides that during treatment, I maintain will provide parents with only with general information about the option progress of using legal means to secure the paymenttreatment, and the patient’s attendance at scheduled sessions. This may involve hiring In some instances, I will also provide parents with a collection agency, which summary of their child’s treatment when it is complete. Any other communication will require the disclosure child’s Authorization, unless I feel that the child is in danger or is a danger to someone else, in which case, I will notify the parents of otherwise confidential my concern. Before giving parents any information. In most collection situations, I will discuss the only information released regarding a patient’s treatment is his/her namematter with the child, the nature of services providedif possible, and the amount due. If such legal action is necessary, the costs will be included in the claim. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits do my best to which you are entitled; however, you (not your insurance company) are responsible for full payment of fees. It is important that you determine exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administratorhandle any objections he/she may have.