Patients' Rights and Responsibilities

MY COMMITMENT TO YOU

To be an effective consumer of psychological services, it is important that you know about your rights and responsibilities and about my obligations to you. Please read this statement carefully and discuss any questions you may have with me.

As a Licensed Psychologist, I am dedicated to providing quality, therapy, testing, coaching and consulting services. You may be assured that each patient receives competent and respectful services regardless of race, ethnic background, religion, sex, age, gender preference, or disability. When necessary, I consult with specialists, and may refer you to additional resources.

I welcome you, your questions and concerns. Your feedback is welcome.

YOUR RIGHTS

When you become a patient/client, you have the right to:

1. Confidentiality. It is my policy to respect your privacy and to protect the confidentiality of your relationship with me. It is also my policy to inform you of the limits I have in protecting this right to confidential care. Limitations imposed by state statute and/or ethical guidelines are as follows:
1. I am encouraged to confer with other professionals when helpful and appropriate, provided I have the proper release from you.
2. Florida Law obliges me to inform relevant parties when there is a clear and imminent danger to the patient, to other individuals or to society. I am also required to report suspected child abuse or neglect. There is also mandated reporting of suspected abuse neglect, or exploitation of aged or disabled adults.
3. When a person licensed under the Florida Psychological Service Act is a party to or defendant in a civil, criminal or disciplinary action arising from a complaint filed by a patient, in which case the waiver is limited to that action. In the event of receiving a subpoena, the patient will be contacted and either a written waiver of objection is expected, or the patient will arrange for his/her attorney to file a protective order, should there be an objection to honoring the subpoena. A copy of the motion and the protective order will need to be forwarded to my office. A fee will be charged for copying records and for any time required by the legal process.
4. If you are asking this office to provide information necessary to file insurance claims, please understand that we have no control over who at the insurance company will see the paperwork or what database will contain your private information. Using your insurance likely requires a mental disorder diagnosis which may limit future insurance options, employment opportunities, public office etc. We normally bill either electronically or via US Mail. For patients first seen prior to September 1, 2010- As of January 1, 2011 , we no longer submit information to insurance companies. For patients first seen after September 1st, 2010, we will not directly bill insurance from day one. Upon your request, we can provide itemized receipts for you to file with your insurance company. We can also complete reasonable forms they may require to justify your care. We will provide these forms directly to you. You are responsible for your own submissions and any consequence that follows such submission.
5. Parents (including non-custodial parents) have certain legal rights to information concerning a minor child. From a therapeutic standpoint, however, it is important for the child or adolescent to develop a trusting relationship with the therapist. Therefore, I request that parents grant the child confidentiality subject to the above limitations. Of course, I will consult with parents regarding involvement in the treatment process and the child/adolescent's progress.
6. Please be aware that I employ mental health and coaching professionals and that I employ administrative staff. In most cases, I need to share protected information with these individuals for both clinical and administrative purposes, such as scheduling, billing and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff members have been given training about protecting your privacy and have agreed not to release any information outside of the practice without the permission of a professional staff member.
7. Except in the circumstances outlined above, I will not release to others any information regarding you and/or my services to you unless you request and authorize with your signature. On our website, you will find the required Federal notice regarding Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides additional privacy protections and additional patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.
2. Cost of Services . You have the right to be informed of the cost of professional services prior to receiving services.
3. Informed Consent . As a patient/parent/guardian, you have the right to know the nature of the services you or your child/adolescent is receiving. In the first sessions, we will discuss goals and design a treatment plan to meet your needs. I encourage you to be active in those discussions. My treatment philosophy is short-term, goal-directed cognitive-behavior therapy with patient –therapist teamwork.
4. Risks . Since the process of change can sometimes be upsetting, the self-analysis and examination of relationships during the course of treatment may carry a slight risk of psychological distress. In some situations, examination of relationships during the course of treatment may result in a decision to make changes in those relationships. If there is ever any distress, please bring those thoughts and emotions to my attention. AS AN OUTPATIENT PRACTICE, THERE IS LIMITED ABILITY TO RESPOND TO EMERGENCIES. If you or your child is experiencing a life threatening emergency, please dial 911.GENERAL HOSPITAL EMERGENCY ROOMS MAY ALSO BE OF ASSIST. After hours calls will not be returned unless communicated as an emergency in my emergency number mailbox.
5. Dual Relationships . Ethical guidelines prohibit any other relationship developing outside the patient-Doctor relationship. In Florida, the patient-Doctor relationship is a lifetime relationship.
6. Ethical guidelines prohibit any exchange of gifts between therapist and patient.

YOUR RESPONSIBILITIES

1. You are responsible for supplying accurate and complete information about yourself/your child-including past illnesses, previous therapy, medication, and family history, when appropriate, and to provide information updates.
2. You are responsible for honoring your financial agreement. Payment for psychological services is due at the time services are rendered. My fee is $225 for initial evaluation and $175 for 45-minute follow-up sessions. Fees for testing, groups, workshops, and organizational consultation are negotiated on a situational basis. It is my practice to charge for other professional services such as telephone conversations which last longer than five minutes, letters, attendance at meetings or consultations with other professionals which you have authorized, or the time required for any service which you request of me. Unreasonable treatment plan requests by insurance companies may also carry charges. These charges will be prorated from your per session rate.
3. You(parent/guardian) are responsible for keeping appointments. Missed appointments, except in rare emergencies will be billed. Insurance companies cannot be billed for this charge. The patient/family is personally responsible for the whole amount. Non-payment of fees can result in termination of services and referral to other providers.
4. If I must be involved in litigation because of professional services provided to you: 1) I must be paid a forensic professional fee , $300 per hour ; 2) a retainer must be paid in advance based on an estimate of minimum time required; 3) out of office services forensic services are charged on a portal to portal basis. The forensic fee will be applied to all services connected to the litigation, including but not limited to letters and reports, phone conferences, depositions, and court appearances.
5. You (child/adolescent and parent/guardian) are responsible for following treatment recommendations, completing therapeutic assignments, and communicating your treatment progress.

To learn more about our services or to schedule a convenient appointment, please click here or call us at (954) 659-0059.

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