IN AN EMERGENCY. A special mobile phone is held by a member of the Management Committee; if there is an emergency at the Hall please call the number below to obtain guidance on the issue:
IN AN EMERGENCY. What do you want your caregiver to do in an emergency? After calling emergency services, who else should be notified? List names and numbers here. Name: Name: Name: Name: Phone Number: Phone Number: Phone Number: Phone Number:
IN AN EMERGENCY. You agree that We and Our agents, representatives and contractors may enter the Supply Address if You are not there provided that the Supply Address is left no less secure by reason of such entry and provided that We pay You reasonable compensation for any damage caused to Your property by Us or by Our agents, representatives or contractors in obtaining such entry.
IN AN EMERGENCY the CVL IM shall, within a reasonable time of the occurrence of the Emergency, give notice to the Adjacent Facility Owner:
(a) of the circumstances giving rise to the Emergency;
(b) the action taken by the CVL IM to deal with the Emergency;
(c) the impact of its actions on the Connecting Network and the Connection Point; and
(d) an indication of the timescale for reinstating the connection and allowing rolling stock access to the Adjacent Facility.
IN AN EMERGENCY. Contact me via email and voicemail, you may also go to the emergency room or dial 911.
IN AN EMERGENCY. Contact me via text, e-mail and voicemail. You may also go to the emergency room, dial 911 or Crisis Hotline number 888-724- 7240.
IN AN EMERGENCY. Emergencies occurring after office hours may require you contacting me at the number above. I will make every effort to make myself available for your care. If, however, you are unable to contact me during an emergency, call 911 or go to the emergency room of the Community Hospital of the Monterey Peninsula (CHOMP) or the Xxxxxxxxx Medical Center. XXXXX also has a crisis line at 000-000-0000. The National Suicide Prevention Lifeline Call 0-000-000-0000
IN AN EMERGENCY. You may contact the Xxxxx Behavioral Health Community Crisis Stabilization program: 000 000 0000, EMAIL/SOCIAL MEDIA: In general, email/text is the quickest way to reach me and used to communicate appointment logistics and/or general information. I do not use email or texting to provide therapy and be aware that email/text conversations can become part of your legal record. Please reserve confidential and sensitive therapeutic topics for the clinical hour, to protect your
IN AN EMERGENCY. Please note that I will not be available for clinical emergencies, either within business hours or after hours. In the case of a clinical emergency, please call the King County Crisis Line (000-000-0000), call 911, or go to a hospital emergency room. Once you are able, please do inform me of the emergency that has occurred. PRIVACY POLICY: By signing below, you agree to understanding and upholding the entirety of this Treatment Agreement document. By signing below you also acknowledge receipt of my HIPAA Notice of Privacy Policies (the very last two pages of this document). This Notice provides information about how I may use and disclose your private health information. I encourage you to read it carefully. My Notice is subject to change. Client Signature Client Printed Name Date Second Client Signature Second Client Printed Name Date Therapist Signature Date Please take a few moments to fill out the following 3 pages of the Intake Form, as it is helpful for your therapist to understand some of your past and present experiences and challenges. *If you are attending couples counseling, please have each partner fill out this Intake form. Thank you. Occupation: Military? Date and branch: If so, when? For what reasons? How was that experience for you? Depression Suicidal Thoughts Career/Work Self –Control Anxiety Eating Disorders Health Cutting/Self-Mutilation Fear/Phobia Abuse Relationships Family issues Other Mental Disorder Grief/loss Sexual Identity Drugs/Alcohol Stress Anger Sleep/Insomnia Divorce Sexual Problems Other: Other: Other: Are you currently experiencing, or have you ever experienced, any of the following: Extremely depressed mood: Currently: Y / N Past: Y / N Wild Mood swings: Y / N Y / N Rapid speech: Y / N Y / N Extreme anxiety: Y / N Y / N Panic attacks: Y / N Y / N Difficulty concentrating: Y / N Y / N Phobias: Y / N Y / N Hallucinations: Y / N Y / N Frequent body complaints: Y / N Y / N Eating disorder: Y / N Y / N Body image problems: Y / N Y / N Repetitive or obsessive thoughts: Y / N Y / N Repetitive Behaviors (frequent checking, hand washing): Y / N Y / N Homicidal Thoughts: Y / N Y / N Suicide Attempt: Y / N Y / N Partner’s name: Partner’s occupation: How long have you been together? Are you married? Y / N For how long? Do you have children? If so, what age are they? How would you say your relationship has been? What would you say are the current challenges in your relationship: Family or friend: Healththcare professional Name: Conta...
IN AN EMERGENCY. The Depot Facility Owner shall, within a reasonable time of the occurrence of the Emergency, give notice to the Adjacent Facility Owner:
(a) of the circumstances giving rise to the Emergency;
(b) the action taken by The Depot Facility Owner to deal with the Emergency;
(c) the impact of its actions on the Connecting Network and the Connection Point; and
(d) an indication of the timescale for reinstating the connection and allowing rolling stock access to the Adjacent Facility.
