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Policies

I feel it is important to clearly state policies that I have set forth so that we can have a positive working relationship. Please review the below policies and ask any questions during your appointments. I will have you sign off that you have read, understand and agree to abide by these policies during your initial visit.

Appointments

I am a non-emergency practice and sessions are by appointment only. Therapy sessions are generally scheduled for 45 to 50 minutes. Because the appointment is reserved for you, it is necessary to charge for appointments that you arrive over 15 minutes late for, are not kept, or not cancelled within 24 business hours of their scheduled time. Exceptions are only made in weather or medical emergencies and are at the discretion of myself. If an appointment is missed you will be charged a $50.00 fee and this will not be covered by your insurance. This fee must be paid prior to your next appointment if you wish to be seen. In addition, if there are two missed appointments all future appointments may be cancelled without notice and you may be discharged from my care. This will be determined case by case. If you have not been seen within three months, you will be discharged from my care and no longer considered a patient under my care. If you wish to be seen again, you will need to reschedule as a new patient at that time.

Court Appearances

The purpose of my work is to provide clinical intervention that assists in symptom reduction. I do not provide evaluations for any court processes such as custody, visitation disputes, or criminal charges. Should these services be required before or after treatment has begun, I can refer you to the appropriate professional that can provide these services. If at any point there are legal proceedings and I receive a subpoena you will be charged for the entire time I am away from the office. I will need at least a five-business day notice if court should be cancelled or you will be charged for nine hours. In addition, if I need to seek legal representation you will also be responsible for these fees. The fees for court appearance range form $250 to $400 per hour.

Termination

Termination of psychotherapy may occur at any time and either of us may initiate it when we believe it is in your best interest to do so. I ask that we meet for at least one last session to review our work together. If any referral is warranted, it will be made at that time. If you are dissatisfied with any aspect of our work, please raise it with me immediately, as it will make our working together slower and more difficult if not resolved. If you believe that you have been treated unethically by me or any therapist and cannot resolve this problem with me you can contact the State Board of Social Work.

Phone Calls/E-Mail

I cannot always be reached by phone immediately, but will make every effort to return calls as efficiently as possible. If you have a concern that you feel cannot wait until our next scheduled appointment time, please call and leave a detailed voice mail. If there is an emergency and you cannot reach me, please follow the following protocol. First, call 911 if it is a life threatening situation. Second, if you need guidance on what you should do you can either call Snowden at Fredericksburg at 540/741-3900 or the Rappahannock Community Services Board at 540/373-6876- both of these numbers have 24hour assistance. Please note that if a phone call exceeds 5 minutes of my time you may be billed for the call. You can also reach me by email for updates or to change appointment times. Please be aware that I do not provide therapy on the phone or by email. Finally, if you are in an emergency situation and my cell number is given, please note that Voice Mail on this is not confidential and that any information that is received may be viewed by others.

Letter Requests

During treatment there may be times you will need documentation for such things as work, school and court. If this should arise please notify me as soon as possible to discuss the options. Letter requests range in cost and are not covered by your insurance.

Confidentiality

As a social worker licensed by the Commonwealth of Virginia and as a member of the National Association of Social Workers, I agree to abide by and uphold the most responsible, ethical and professional standards possible. I regard the information you share with me with the greatest respect so I want to be as clear as possible about how it will be handled. In general, I can tell no one what you tell me or even acknowledge that you are a client. State law and professional ethical principles in all but a few rare circumstances legally protect the privacy and confidentiality of records. Specifically, the exceptions to confidentiality are: 1) When I have reason to believe you intend to harm yourself or another person, 2) When I have reason to believe a minor child (under age 18) has been or will be abused or neglected and 3) When your records have been subpoenaed by a legitimate court order (or you are being treated by me under a court order).

Patients who are dependent/minors: As the therapist of a dependent/minor, it is important that the patient is able to completely trust me. As such, I keep confidential what the minor says in the same way that I keep confidential what an adult says. As the parent/guardian, you have the right and responsibility to question and understand the nature of my activities and progress with the minor and I must use my clinical discretion as to what is appropriate disclosure. In general, I will not release specific information that the minor provides to me. However, I feel it is important to discuss with you, the parent/guardian, the minor's progress and your participation in their treatment. For children of divorced or separated parents please note that both parents are entitled to the child's medical records unless the courts have ruled otherwise.

Please Note: If a portion of your treatment expense is covered by insurance, they may require me to provide certain information about your diagnosis and care. If you have questions about information to be released, please bring it to my attention for discussion. Delinquent accounts may be turned over to a collection agency, but you will be notified in advance of this action. Psychotherapy notes will not be released to the collection agency.

-EMAIL: Due to having a small practice I depend on using email to communicate with my clients outside of your appointment time. I follow HIPAA regulations when it comes to using electronic communication.

-RECORDING SESSIONS: At no time are you permitted to either video or verbally record treatment sessions.

HIPAA

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (HIPAA), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, and the NASW Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
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.
For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law. Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Without Authorization. Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations. As a social worker licensed in this state and as a member of the National Association of Social Workers, it is our practice to adhere to more stringent privacy requirements for disclosures without an authorization. The following language addresses these categories to the extent consistent with the NASW Code of Ethics and HIPAA.
Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.
Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent), court order, administrative order or similar process.
Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person's estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.
Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.
Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
Specialized Government Functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Research. PHI may only be disclosed after a special approval process or with your authorization.
Fundraising. We may send you fundraising communications at one time or another. You have the right to opt out of such fundraising communications with each solicitation you receive.
Verbal Permission. We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices.

YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at 3715 Latimers Knoll Court, Suite 106 Fredericksburg, VA 22408.
1) Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a "designated record set". A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychotherapy notes. We may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.
2) Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please contact the Privacy Officer if you have any questions.
3) Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
4) Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.
5) Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. We may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. We will not ask you for an explanation of why you are making the request.
6) Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.
7) Right to a Copy of this Notice. You have the right to a copy of this notice.

COMPLAINTS
If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at 3715 Latimers Knoll Court Suite 106 Fredericksburg, VA 22408 or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.

The effective date of this Notice is September 2013.