State-Required Disclosure Statement
Washington State law requires that I inform you: "Counselors practicing counseling for a fee must be licensed with the Department of Licensing for the protection of the public health and safety. Licensure of an individual does not include recognition of any practice standards nor necessarily implies the effectiveness of any treatment."
Client Rights & Responsibilities
Missed Appointment and Late Cancellation Policy
My clients' privacy is of utmost concern and importance to me and therefore I adhere to current standards as outlined in the Federal guidelines as stated in the Health Information Portability Accountability Act (HIPAA). Put simply, this generally means for my clients that what is said in session stays in session except in the narrow circumstances described below.
Additionally, for those wishing to use their insurance benefits to assist in managing the cost of mental health services. Your insurance company will require some information from me about your diagnosis, type of service provided (individual, family, group therapy), and may inquire about the symptoms you are experiencing and level of severity in order to determine whether services provided are medically necessary, and therefore covered by your insurance plan. Your insurance company also has the right to review your record as part of their auditing process to check on a provider's adherence to providing services that are the least invasive required, medically necessary, and that the documentation existing in a record supports this and supports the assigned diagnosis. By using your insurance to cover your services you are providing your consent to your insurance company to have access to this information. You have the right pay for services yourself without using your insurance benefits and to pay me directly for all services rendered.
If you would like to obtain a list or copy of the acts of unprofessional conduct listed under RCW18.130.180 you may contact the Department of Health at the following address and phone numbers: HSQA Complaint Intake, PO Box 47857, Olympia, WA 98504-7857; Phone: (360) 236-4700; E-mail: [email protected]
Mental Health Records
As stated above, your mental health record, like your medical record ultimately belongs to you as my client. At this time, I use an electronic health record (EHR) product called Practice Fusion, to maintain clinical records for clients with whom I work. Practice Fusion meets all HIPAA requirements. You may request a printed copy of your record at any time though copying fees may apply. Unfortunately at this time I am unable to provide an electronic copy of your record. If you are requesting your mental health record I recommend we set aside time to discuss contents of your mental health record before I provide you with a printed copy or provide a copy to a third party so you are aware, if you are not already, of what information is contained in the record and have the opportunity to obtain any clarification on information in the record as you may need/want it. Any information shared during contact with me as your provider may be entered as I deem relevant to the therapy services provided. If you disagree with information in the record, though I cannot delete information once entered, you, as the client, may request a written addendum to the record to clarify your concerns about any entry in the record. After you complete treatment with me, your record will continue to be stored for 10 years (or based on requirements as dictated by current laws at the time you complete treatment). Therefore in the event you should need access to your record after treatment has ended you will be able to request it as needed. At that time, your mental health record continues to be stored in accordance HIPAA standards.
Mental Health Emergencies, After Hours, and Back-Up Coverage
There may be times it is clinically indicated that I may myself available to provide telephone based support to a client after hours or in case of emergency. In those circumstances I will discuss with clients how to reach me and the parameters in which I may be contacted after hours.
As a rule however, if clients need after hours or emergency mental health support, I recommend they use the emergency mental health resources noted on the resources page of this website.
If I am required to be out of the office and I am aware of clients needing support while I am out of the office, I will inform you of a clinician(s) that you may contact for such support. Support received from those providers may incur fees from back-up care providers at the rate charged by that specific provider.
Washington State law requires that I inform you: "Counselors practicing counseling for a fee must be licensed with the Department of Licensing for the protection of the public health and safety. Licensure of an individual does not include recognition of any practice standards nor necessarily implies the effectiveness of any treatment."
Client Rights & Responsibilities
- Clients have a right to receive treatment regardless of race, ethnicity, gender, sexual orientation, or socioeconomic status.
- Clients have a right to privacy (see below for privacy policy).
- Clients have a right to choose their provider.
- Clients have a right to be informed of their diagnosis and to be informed of treatment recommendations available. Clients have a right to choose what types of treatment to engage in and to cease engagement in treatment at any time in the therapy process. Clients are however encouraged to discuss premature termination of treatment with provider first to discuss any risks associated with early termination of treatment.
- Clients' mental health record, like their medical record, ultimately belongs to the client though is maintained by the provider. Clients have the right to review and obtain a printed copy of their record. At this time I am unable to provide electronic copy of the record. Copying fees may apply.
- Clients have a right to bring forth disagreements related to the treatment process/experience and have a right to have such matters resolved in a timely manner.
- Clients are responsible for all fees due to me the provider at time services are rendered. If for any reason full fee due to me is not collected at time services are rendered, I reserve the right as the provider to bill for any changes remaining. Services may be suspended if a balance for a client's account is present. Services will resume promptly when the account returns to a $0.00 balance.
Missed Appointment and Late Cancellation Policy
- Though I respect that we all experience times in which unforeseen circumstances occur that require making changes to appointments/missing an appointment, as a small business owner, to sustain my practice I must charge for late cancellations and missed appointments. The fee for late cancellations and missed appointments is $125.00 (rate will increase to $140.00 beginning March 1, 2024).
- Cancellation of appointments that occur with less than 1 business days notice. Providing such notice allows me sufficient time to offer the appointment to another client.
- In recognition of unforeseen circumstances that any client might experience that may disrupt appointments, clients are afforded one missed appointment/late cancellation per year for which I will waive the above fee. Such waiver of fee may, at my discretion, be considered and extended beyond this one visit per year based upon review of the situation/reason for late cancellation. I encourage clients to discuss with me any situation that may result in their need to cancel an appointment with less than 1 business days notice so that we may work together to plan accordingly.
- Clients should assume that such fees will not be paid by their insurer and will be paid out-of-pocket by the client to me, the provider. Insurance plans do not generally cover such fees.
- This policy applies to all patients with exception of those clients receiving services under Compsych and First Choice Health EAP plans.
My clients' privacy is of utmost concern and importance to me and therefore I adhere to current standards as outlined in the Federal guidelines as stated in the Health Information Portability Accountability Act (HIPAA). Put simply, this generally means for my clients that what is said in session stays in session except in the narrow circumstances described below.
- I will provide information about your treatment to another person (such as another care provider) if you give me your written permission to do so.
- If in my professional opinion I believe you, as my client, are at imminent risk to the safety of yourself or others, I am required by law and professional code of ethics to take appropriate steps to ensure the safety of you as my client and the community. In such instances only those that need to be notified will be called upon to assist me in securing your safety and the well-being of the community at large.
- As a mental health provider I am a mandated reporter. This means I am required by law to report any suspected or known abuse of a minor or vulnerable adult. In such instances it is my duty to report such concerns to Child Protective Services (CPS) or Adult Protective Services (APS) or local law enforcement/911.
- I am required to comply with any lawful court order for information.
- Like other therapists, at times I sometimes consult with other therapist or care providers to help me provide the best care for my clients. Client information is protected and confidentiality rules protecting your privacy bind anyone with whom I consult.
- Limits to privacy may exist when clients choose to exchange information or allow other parties to exchange information on their behalf through e-mail, fax, or cell phone based communication.
Additionally, for those wishing to use their insurance benefits to assist in managing the cost of mental health services. Your insurance company will require some information from me about your diagnosis, type of service provided (individual, family, group therapy), and may inquire about the symptoms you are experiencing and level of severity in order to determine whether services provided are medically necessary, and therefore covered by your insurance plan. Your insurance company also has the right to review your record as part of their auditing process to check on a provider's adherence to providing services that are the least invasive required, medically necessary, and that the documentation existing in a record supports this and supports the assigned diagnosis. By using your insurance to cover your services you are providing your consent to your insurance company to have access to this information. You have the right pay for services yourself without using your insurance benefits and to pay me directly for all services rendered.
If you would like to obtain a list or copy of the acts of unprofessional conduct listed under RCW18.130.180 you may contact the Department of Health at the following address and phone numbers: HSQA Complaint Intake, PO Box 47857, Olympia, WA 98504-7857; Phone: (360) 236-4700; E-mail: [email protected]
Mental Health Records
As stated above, your mental health record, like your medical record ultimately belongs to you as my client. At this time, I use an electronic health record (EHR) product called Practice Fusion, to maintain clinical records for clients with whom I work. Practice Fusion meets all HIPAA requirements. You may request a printed copy of your record at any time though copying fees may apply. Unfortunately at this time I am unable to provide an electronic copy of your record. If you are requesting your mental health record I recommend we set aside time to discuss contents of your mental health record before I provide you with a printed copy or provide a copy to a third party so you are aware, if you are not already, of what information is contained in the record and have the opportunity to obtain any clarification on information in the record as you may need/want it. Any information shared during contact with me as your provider may be entered as I deem relevant to the therapy services provided. If you disagree with information in the record, though I cannot delete information once entered, you, as the client, may request a written addendum to the record to clarify your concerns about any entry in the record. After you complete treatment with me, your record will continue to be stored for 10 years (or based on requirements as dictated by current laws at the time you complete treatment). Therefore in the event you should need access to your record after treatment has ended you will be able to request it as needed. At that time, your mental health record continues to be stored in accordance HIPAA standards.
Mental Health Emergencies, After Hours, and Back-Up Coverage
There may be times it is clinically indicated that I may myself available to provide telephone based support to a client after hours or in case of emergency. In those circumstances I will discuss with clients how to reach me and the parameters in which I may be contacted after hours.
As a rule however, if clients need after hours or emergency mental health support, I recommend they use the emergency mental health resources noted on the resources page of this website.
If I am required to be out of the office and I am aware of clients needing support while I am out of the office, I will inform you of a clinician(s) that you may contact for such support. Support received from those providers may incur fees from back-up care providers at the rate charged by that specific provider.