Common use of Minors and Parents Clause in Contracts

Minors and Parents. Clients under the age of 18 years of age and their parents should be aware that the law may allow parents/guardians to examine their child’s treatment records. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes Xxxxxxxx’s policy to request an agreement from parents that they consent to relinquish access to their child’s records. If parents/guardian agree, during treatment Cathexis will provide general information about the child’s treatment and progress. Any other communication will require the child’s authorization unless it is believed that the child is in danger or is a danger to someone else in which case Cathexis will notify the parents/guardian of the concern. Before giving parents any information, Xxxxxxxx will discuss this matter with the child and, if possible, handle objections. Additionally, such information may be released and discussed during a conjoint session. YOUR RIGHTS AND RESPONSIBILITIES AS A CLIENT OF CATHEXIS When you receive services from Cathexis you have the right to: - Receive high-quality service - Receive privacy during counseling - Be treated with dignity, respect and consideration - Have your information kept private and confidential except as described in Cathexis Privacy Statement - Be listened to and have staff work with you to make a plan to address your concerns and needs - Receive service in offices that are safe, clean and accessible, and respectful of your individuality, choices, strengths and abilities - Get information and support to help you make decisions to improve your situation - Be served without harassment or discrimination based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis - Discuss your service with staff to identify if it is working for you and express any questions or complaints that you may have; at any time, you have the right to refuse counseling - Request a change of staff member if there is another staff person available who can address your issues and your request is reasonable -- you should know that discriminatory requests will not be considered. Patient also has the right to request a referral to another health care institution if you feel the care you are receiving from Cathexis is not improving your situation - To participate, or have your legal guardian participate in the development of, or decisions concerning the counseling provided at Cathexis - To participate or refusal to participate in research or experimental treatment - To receive from family, legal guardian or others individual assistance in understanding and exercising your patient’s rights - Have the ability to review, upon written request, patient’s own medical files or financial records according to A.R.S. §§ 12-2293, 12- 2294, and 12-2294.01 - Receive a referral to another health care institution if the counseling facility is not authorized or not able to provide the behavioral health services needed by the patient - It is not Cathexis’ usual practice to photograph our clients, but if a circumstance arises, patient has a right to accept or decline in writing This is what we ask from you: - Treat the staff and others at Cathexis with courtesy and respect - Let your assigned counselor or Cathexis staff know when you will not be able to keep a scheduled appointment at least 24 hours in advance. Please understand that most of our counselors are on site for scheduled appointments only. As a courtesy to your counselor, please give them ample notice of cancellation - Should you have concerns or complaints regarding the care you have received from Cathexis, we ask that you follow the Patient Complaint Process described in the following section Patient Complaint Process Policy and Procedures Preamble Cathexis values and encourages the feedback of its clients regarding the programs and practices of the organization. Complaints can provide important opportunities for improving service. A complaint may be defined as an expression of dissatisfaction or unmet expectation. A complaint can be made by the patient with support if necessary. The complaint can relate to any aspect of the organization’s programs and services. A patient or legal guardian who believes they have experienced discrimination at Cathexis can file a claim about this facility with the Arizona Department of Health Services by utilizing the Medical Licensing Online Complaint Form, found at xxxxx://xxx.xxxxx.xxx/Is/online_complaint.aspx, or by contacting the department at 000-000-0000 or 000 X 00xx Xxx Xxx 000, Xxxxxxx, XX 00000. Privacy Officer The Privacy Officer for Cathexis is the Chief Administrative Officer, Xxxxx Xxxxx, who can be contacted at 000-000-0000. POLICY Cathexis is committed to listening to patient complaints and responding in a fair, timely and respectful manner. All complaints will be given due consideration without reprisal or discrimination. Language support for non-English speaking patients will be provided. Cathexis actively informs patients of their right to register complaints (verbal or written) and seek resolution. This information is accessible and publicized in Cathexis Client Rights and Responsibilities, and is available on our website or by request. Patients who speak languages other than those covered by the latter documents or who have reading difficulties are encouraged to have this policy explained to them by a Cathexis staff person at the beginning of service. Cathexis will assist persons with disabilities to register their complaints and seek resolution. All aspects of a complaint will be handled in confidence. However, if the complaint involves allegations of illegal or unethical behavior, information may need to be shared with external authorities. All complaints are documented. The maintenance of complaint files is the responsibility of the Chief Administrative Officer. Complaints deemed a risk to the organization are brought forward to the Chief Administrative Officer or the Chief Executive Officer/Clinical Director, who will review the details of the situation and decide on the appropriate and immediate action. The Chief Executive Officer/Clinical Director will record the details of the complaint and actions taken to resolve the issue, and will be revisited at the shareholder Cathexis Quality Management Program Annual Review Meeting. Clients with questions, comments or complaints about Cathexis privacy policies and procedures or about the collection, use or disclosure of their personal information will be directed to the Privacy Officer.

Minors and Parents. Clients Patients under the age of 18 years of age who are not emancipated and their parents should be aware that the law may allow parents/guardians parents to examine their child’s 's treatment records. Because However, if the treatment is for suicide prevention, chemical addiction or dependency, or sexual, physical or emotional abuse, the law provides that parents may not access their child's records. For children between 16 and18, because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes Xxxxxxxx’s our policy to request an agreement from the patient and his/her parents that they the parents consent to relinquish give up their access to their child’s 's records. If parents/guardian they agree, during treatment Cathexis treatment, the psychologist will provide them only with general information about the progress of the child’s 's treatment, and his/her attendance at scheduled sessions. We will also provide parents with a summary of their child's treatment and progresswhen it is complete. Any other communication will require the child’s authorization 's Authorization, unless it is believed the doctor feels that the child is in danger or is a danger to someone else else, in which case Cathexis case, the psychologist will notify the parents/guardian parents of the concern. Before giving parents any information, Xxxxxxxx the doctor will discuss this the matter with the child andchild, if possible, and we will do our best to handle objectionsany objections he/she may have. AdditionallyBILLING AND PAYMENTS You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage that requires another arrangement. Payment schedules for other professional services will be agreed to when they are requested. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court which will require us to disclose otherwise confidential information. In most collection situations, the only information we release regarding a patient's treatment is his/her name, the nature of services provided, and the amount due. If such information may legal action is necessary, its costs will be released included in the claim. INSURANCE REIMBURSEMENT In order for us to set realistic treatment goals and discussed during priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a conjoint sessionhealth insurance policy, it will usually provide some coverage for mental health treatment. YOUR RIGHTS AND RESPONSIBILITIES AS A CLIENT OF CATHEXIS When We will fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of our fees. It is very important that you find out exactly what mental health services from Cathexis 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 right to: - Receive high-quality service - Receive privacy during counseling - Be treated coverage, call your plan administrator. Of course, we will provide you with dignity, respect whatever information we can based on our experience and consideration - Have your information kept private and confidential except as described in Cathexis Privacy Statement - Be listened to and have staff work with you to make a plan to address your concerns and needs - Receive service in offices that are safe, clean and accessible, and respectful of your individuality, choices, strengths and abilities - Get information and support will be happy to help you make decisions in understanding the information you receive from your insurance company. If it is necessary to improve clear confusion, we will be willing to call the company on your situation - Be served without harassment behalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. "Managed Health Care" plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person's usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While much can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-care plans will not allow your doctor to provide services to you once your benefits end. If this is the case, we will do our best to find another provider who will help you continue your psychotherapy. You should also be aware that your contract with your health insurance company requires that we provide it with information relevant to the services provided to you. We are required to provide a clinical diagnosis. Sometimes we are required to provide additional clinical information such as treatment plans or discrimination based on race, national origin, religion, gender, sexual orientation, age, disability, marital statussummaries, or diagnosis - Discuss copies of your service entire Clinical Record. In such situations, we will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, we have no control over what they do with staff to identify if it once it is working for in their hands. In some cases, they may share the information with a national medical information databank. We will provide you with a copy of any report we submit, if you request it. By signing this Agreement, you agree that we can provide requested information to your carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and express any questions or complaints what will happen if they run out before you feel ready to end your sessions. It is important to remember that you may have; at any time, you always have the right to refuse counseling - Request a change pay for our services yourself to avoid the problems described above. WELCOME TO OUR PRACTICE. WE LOOK FORWARD TO WORKING WITH YOU! Signature of staff member if there is another staff person available who can address your issues and your request is reasonable -- you should know that discriminatory requests will not be considered. Patient also has the right to request a referral to another health care institution if you feel the care you are receiving from Cathexis is not improving your situation - To participate, or have your legal guardian participate in the development of, or decisions concerning the counseling provided at Cathexis - To participate or refusal to participate in research or experimental treatment - To receive from family, legal guardian or others individual assistance in understanding and exercising your patient’s rights - Have the ability to review, upon written request, patient’s own medical files or financial records according to A.R.S. §§ 12-2293, 12- 2294, and 12-2294.01 - Receive a referral to another health care institution if the counseling facility is not authorized or not able to provide the behavioral health services needed by the patient - It is not Cathexis’ usual practice to photograph our clients, but if a circumstance arises, patient has a right to accept or decline in writing This is what we ask from you: - Treat the staff and others at Cathexis with courtesy and respect - Let your assigned counselor or Cathexis staff know when you will not be able to keep a scheduled appointment at least 24 hours in advance. Please understand that most of our counselors are on site for scheduled appointments only. As a courtesy to your counselor, please give them ample notice of cancellation - Should you have concerns or complaints regarding the care you have received from Cathexis, we ask that you follow the Patient Complaint Process described in the following section Patient Complaint Process Policy and Procedures Preamble Cathexis values and encourages the feedback of its clients regarding the programs and practices of the organization. Complaints can provide important opportunities for improving service. A complaint may be defined as an expression of dissatisfaction or unmet expectation. A complaint can be made by the patient with support if necessary. The complaint can relate to any aspect of the organization’s programs and services. A patient or legal guardian who believes they have experienced discrimination at Cathexis can file a claim about this facility with the Arizona Department of Health Services by utilizing the Medical Licensing Online Complaint Form, found at xxxxx://xxx.xxxxx.xxx/Is/online_complaint.aspx, or by contacting the department at 000-000-0000 or 000 X 00xx Xxx Xxx 000, Xxxxxxx, XX 00000. Privacy Officer The Privacy Officer for Cathexis is the Chief Administrative Officer, Xxxxx Xxxxx, who can be contacted at 000-000-0000. POLICY Cathexis is committed to listening to patient complaints and responding in a fair, timely and respectful manner. All complaints will be given due consideration without reprisal or discrimination. Language support for non-English speaking patients will be provided. Cathexis actively informs patients of their right to register complaints (verbal or written) and seek resolution. This information is accessible and publicized in Cathexis Client Rights and Responsibilities, and is available on our website or by request. Patients who speak languages other than those covered by the latter documents or who have reading difficulties are encouraged to have this policy explained to them by a Cathexis staff person at the beginning of service. Cathexis will assist persons with disabilities to register their complaints and seek resolution. All aspects of a complaint will be handled in confidence. However, if the complaint involves allegations of illegal or unethical behavior, information may need to be shared with external authorities. All complaints are documented. The maintenance of complaint files is the responsibility of the Chief Administrative Officer. Complaints deemed a risk to the organization are brought forward to the Chief Administrative Officer or the Chief Executive Officer/Clinical Director, who will review the details of the situation and decide on the appropriate and immediate action. The Chief Executive Officer/Clinical Director will record the details of the complaint and actions taken to resolve the issue, and will be revisited at the shareholder Cathexis Quality Management Program Annual Review Meeting. Clients with questions, comments or complaints about Cathexis privacy policies and procedures or about the collection, use or disclosure of their personal information will be directed to the Privacy Officer.Date

Minors and Parents. Clients under the age of 18 years of age and Minors have a limited right to privacy in that their parents should be aware that may have the law may allow parents/guardians right to examine access their child’s treatment records. .Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes Xxxxxxxx’s policy we need to request an agreement from consider carefully the clinical ramifications of parents that they consent to relinquish access to viewing their child’s recordsrecord. If parents/guardian agree, during treatment Cathexis will It is my preference to provide parents only with general information about the progress of the child’s treatment and progress. Any other communication will require the child’s authorization his/her attendance at scheduled sessions unless it is believed I feel that the child is in danger or is a danger to someone else else, in which case Cathexis case, I will notify the parents/guardian parents of the my concern. Before giving parents any information, Xxxxxxxx I will discuss this the matter with the child andchild, if possible, and do my best to handle objections. Additionally, such information may be released and discussed during a conjoint session. YOUR RIGHTS AND RESPONSIBILITIES AS A CLIENT OF CATHEXIS When you receive services from Cathexis you have the right to: - Receive high-quality service - Receive privacy during counseling - Be treated with dignity, respect and consideration - Have your information kept private and confidential except as described in Cathexis Privacy Statement - Be listened to and have staff work with you to make a plan to address your concerns and needs - Receive service in offices that are safe, clean and accessible, and respectful of your individuality, choices, strengths and abilities - Get information and support to help you make decisions to improve your situation - Be served without harassment or discrimination based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis - Discuss your service with staff to identify if it is working for you and express any questions or complaints that you objections he/she may have; at any time, you have the right to refuse counseling - Request a change of staff member if there is another staff person available who can address your issues and your request is reasonable -- you should know that discriminatory requests will not be considered. Patient also has the right to request a referral to another health care institution if you feel the care you REFERRALS There are receiving from Cathexis is not improving your situation - To participate, or have your legal guardian participate in the development of, or decisions concerning the counseling provided at Cathexis - To participate or refusal to participate in research or experimental treatment - To receive from family, legal guardian or others individual assistance in understanding and exercising your patient’s rights - Have the ability to review, upon written request, patient’s own medical files or financial records according to A.R.S. §§ 12-2293, 12- 2294, and 12-2294.01 - Receive a referral to another health care institution if the counseling facility is not authorized or times when I am not able to provide services for all conditions or challenges that clients face. For this reason, a referral may be required. If so, I will provide you with some alternatives. It will be your responsibility to contact and evaluate those referrals. APPOINTMENTS AND FEES Sessions are 45 minutes and the behavioral health fee is $200 for individual and $250 family/couples therapy sessions. In addition to appointments, I may charge this amount for other professional services needed you may need, such as report writing, telephone conversations, consulting with other professionals with your permission, school consultations, preparation of records or treatment summaries. You will be expected to pay for each session at the time it is held. Once an appointment is scheduled, that time has been reserved for you alone so you will be responsible for payment of full amount unless you provide 24 hours advance notice of cancellation. For those paying with a credit card, if you do not cancel within 24 hours, your credit card will be charged for the missed session. If you are not paying by the patient - credit card, then you will be sent a bill. There is a $25.00 fee for each check returned for insufficient funds. If more than one check is returned, payment by cash or credit card may be required. If you become involved in legal proceedings that require my participation, you will be expected to pay for all of my professional time, including preparation and transportation costs, even if I am called to testify by another party. I charge $200.00 per hour for preparation and $350.00 per hour for attendance at any legal proceeding. ELECTRONIC COMMUNICATION Many clients utilize cell phones, email and text to contact me. Additionally, I provide my cell phone number to clients and may use my cell phone to return calls. It is very important to be aware that email, texting and cell phone communication can potentially be accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. Although I maintain firewall and antiviral software, my email address is not Cathexis’ usual practice encrypted. If you choose to photograph our clientscommunicate with me via email, but if a circumstance arisestext or cell phone, patient has a right to accept or decline in writing This is what we ask from you: - Treat the staff and others at Cathexis with courtesy and respect - Let your assigned counselor or Cathexis staff know when you I will not be able to keep a scheduled appointment at least 24 hours in advance. Please understand assume that most of our counselors are on site for scheduled appointments only. As a courtesy to your counselor, please give them ample notice of cancellation - Should you have concerns or complaints regarding made an informed decision, will view it as your agreement to take the care you have received from Cathexis, we ask risk that you follow the Patient Complaint Process described in the following section Patient Complaint Process Policy and Procedures Preamble Cathexis values and encourages the feedback of its clients regarding the programs and practices of the organization. Complaints can provide important opportunities for improving service. A complaint such communication may be defined as an expression of dissatisfaction or unmet expectation. A complaint can be made by the patient with support if necessary. The complaint can relate to any aspect of the organization’s programs and services. A patient or legal guardian who believes they have experienced discrimination at Cathexis can file a claim about this facility with the Arizona Department of Health Services by utilizing the Medical Licensing Online Complaint Form, found at xxxxx://xxx.xxxxx.xxx/Is/online_complaint.aspx, or by contacting the department at 000-000-0000 or 000 X 00xx Xxx Xxx 000, Xxxxxxx, XX 00000. Privacy Officer The Privacy Officer for Cathexis is the Chief Administrative Officer, Xxxxx Xxxxx, who can be contacted at 000-000-0000. POLICY Cathexis is committed to listening to patient complaints and responding in a fair, timely and respectful manner. All complaints will be given due consideration without reprisal or discrimination. Language support for non-English speaking patients will be provided. Cathexis actively informs patients of their right to register complaints (verbal or written) and seek resolution. This information is accessible and publicized in Cathexis Client Rights and Responsibilities, and is available on our website or by request. Patients who speak languages other than those covered by the latter documents or who have reading difficulties are encouraged to have this policy explained to them by a Cathexis staff person at the beginning of service. Cathexis will assist persons with disabilities to register their complaints and seek resolution. All aspects of a complaint will be handled in confidence. However, if the complaint involves allegations of illegal or unethical behavior, information may need to be shared with external authorities. All complaints are documented. The maintenance of complaint files is the responsibility of the Chief Administrative Officer. Complaints deemed a risk to the organization are brought forward to the Chief Administrative Officer or the Chief Executive Officer/Clinical Director, who will review the details of the situation and decide on the appropriate and immediate action. The Chief Executive Officer/Clinical Director will record the details of the complaint and actions taken to resolve the issueintercepted, and will honor your desire to communicate via email, text or cell phone. There may, however, be revisited at times when I determine that email or cell phone is not an appropriate method of communication for certain types of issues or information. Note: All information and correspondence made through your personal account which is setup on the shareholder Cathexis Quality Management Program Annual Review Meetingwebsite has protected transmittion through a portal that is encrypted. Clients with questionsDue to computer or network problems, comments emails may not be deliverable, and I may not check emails daily. Do not use email or complaints about Cathexis privacy policies and procedures text messaging for emergencies. For after hours emergencies or about the collectionif you are in need of immediate assistance, use call 911 or disclosure of their personal information will be directed to the Privacy Officervisit your local emergency room, medical group or primary physician.

Minors and Parents. Clients Patients under the age of 18 years of age who are not emancipated and their parents should be aware that the law may allow parents/guardians parents to examine their child’s 's treatment records. Because However, if the treatment is for suicide prevention, chemical addiction or dependency, or sexual, physical or emotional abuse, the law provides that parents may not access their child's records. For children between 16 and18, because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes Xxxxxxxx’s our policy to request an agreement from the patient and his/her parents that they the parents consent to relinquish give up their access to their child’s 's records. If parents/guardian they agree, during treatment Cathexis treatment, the psychologist will provide them only with general information about the progress of the child’s 's treatment, and his/her attendance at scheduled sessions. We will also provide parents with a summary of their child's treatment and progresswhen it is complete. Any other communication will require the child’s authorization 's Authorization, unless it is believed the doctor feels that the child is in danger or is a danger to someone else else, in which case Cathexis case, the psychologist will notify the parents/guardian parents of the concern. Before giving parents any information, Xxxxxxxx the doctor will discuss this the matter with the child andchild, if possible, and we will do our best to handle objectionsany objections he/she may have. AdditionallyBILLING AND PAYMENTS You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage that requires another arrangement. Payment schedules for other professional services will be agreed to when they are requested. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court which will require us to disclose otherwise confidential information. In most collection situations, the only information we release regarding a patient's treatment is his/her name, the nature of services provided, and the amount due. If such information may legal action is necessary, its costs will be released included in the claim. INSURANCE REIMBURSEMENT In order for us to set realistic treatment goals and discussed during priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a conjoint sessionhealth insurance policy, it will usually provide some coverage for mental health treatment. YOUR RIGHTS AND RESPONSIBILITIES AS A CLIENT OF CATHEXIS When We will fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of our fees. It is very important that you find out exactly what mental health services from Cathexis 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 right to: - Receive high-quality service - Receive privacy during counseling - Be treated coverage, call your plan administrator. Of course, we will provide you with dignity, respect whatever information we can based on our experience and consideration - Have your information kept private and confidential except as described in Cathexis Privacy Statement - Be listened to and have staff work with you to make a plan to address your concerns and needs - Receive service in offices that are safe, clean and accessible, and respectful of your individuality, choices, strengths and abilities - Get information and support will be happy to help you make decisions in understanding the information you receive from your insurance company. If it is necessary to improve clear confusion, we will be willing to call the company on your situation - Be served without harassment behalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. "Managed Health Care" plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person's usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While much can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-care plans will not allow your doctor to provide services to you once your benefits end. If this is the case, we will do our best to find another provider who will help you continue your psychotherapy. You should also be aware that your contract with your health insurance company requires that we provide it with information relevant to the services provided to you. We are required to provide a clinical diagnosis. Sometimes we are required to provide additional clinical information such as treatment plans or discrimination based on race, national origin, religion, gender, sexual orientation, age, disability, marital statussummaries, or diagnosis - Discuss copies of your service entire Clinical Record. In such situations, we will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, we have no control over what they do with staff to identify if it once it is working for in their hands. In some cases, they may share the information with a national medical information databank. We will provide you with a copy of any report we submit, if you request it. By signing this Agreement, you agree that we can provide requested information to your carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and express any questions or complaints what will happen if they run out before you feel ready to end your sessions. It is important to remember that you may have; at any time, you always have the right to refuse counseling - Request a change of staff member if there is another staff person available who can address your issues and your request is reasonable -- you should know that discriminatory requests will not be considered. Patient also has pay for our services yourself to avoid the right to request a referral to another health care institution if you feel the care you are receiving from Cathexis is not improving your situation - To participate, or have your legal guardian participate in the development of, or decisions concerning the counseling provided at Cathexis - To participate or refusal to participate in research or experimental treatment - To receive from family, legal guardian or others individual assistance in understanding and exercising your patient’s rights - Have the ability to review, upon written request, patient’s own medical files or financial records according to A.R.S. §§ 12-2293, 12- 2294, and 12-2294.01 - Receive a referral to another health care institution if the counseling facility is not authorized or not able to provide the behavioral health services needed by the patient - It is not Cathexis’ usual practice to photograph our clients, but if a circumstance arises, patient has a right to accept or decline in writing This is what we ask from you: - Treat the staff and others at Cathexis with courtesy and respect - Let your assigned counselor or Cathexis staff know when you will not be able to keep a scheduled appointment at least 24 hours in advance. Please understand that most of our counselors are on site for scheduled appointments only. As a courtesy to your counselor, please give them ample notice of cancellation - Should you have concerns or complaints regarding the care you have received from Cathexis, we ask that you follow the Patient Complaint Process problems described in the following section Patient Complaint Process Policy and Procedures Preamble Cathexis values and encourages the feedback of its clients regarding the programs and practices of the organization. Complaints can provide important opportunities for improving service. A complaint may be defined as an expression of dissatisfaction or unmet expectation. A complaint can be made by the patient with support if necessary. The complaint can relate to any aspect of the organization’s programs and services. A patient or legal guardian who believes they have experienced discrimination at Cathexis can file a claim about this facility with the Arizona Department of Health Services by utilizing the Medical Licensing Online Complaint Form, found at xxxxx://xxx.xxxxx.xxx/Is/online_complaint.aspx, or by contacting the department at 000-000-0000 or 000 X 00xx Xxx Xxx 000, Xxxxxxx, XX 00000. Privacy Officer The Privacy Officer for Cathexis is the Chief Administrative Officer, Xxxxx Xxxxx, who can be contacted at 000-000-0000. POLICY Cathexis is committed to listening to patient complaints and responding in a fair, timely and respectful manner. All complaints will be given due consideration without reprisal or discrimination. Language support for non-English speaking patients will be provided. Cathexis actively informs patients of their right to register complaints (verbal or written) and seek resolution. This information is accessible and publicized in Cathexis Client Rights and Responsibilities, and is available on our website or by request. Patients who speak languages other than those covered by the latter documents or who have reading difficulties are encouraged to have this policy explained to them by a Cathexis staff person at the beginning of service. Cathexis will assist persons with disabilities to register their complaints and seek resolution. All aspects of a complaint will be handled in confidence. However, if the complaint involves allegations of illegal or unethical behavior, information may need to be shared with external authorities. All complaints are documented. The maintenance of complaint files is the responsibility of the Chief Administrative Officer. Complaints deemed a risk to the organization are brought forward to the Chief Administrative Officer or the Chief Executive Officer/Clinical Director, who will review the details of the situation and decide on the appropriate and immediate action. The Chief Executive Officer/Clinical Director will record the details of the complaint and actions taken to resolve the issue, and will be revisited at the shareholder Cathexis Quality Management Program Annual Review Meeting. Clients with questions, comments or complaints about Cathexis privacy policies and procedures or about the collection, use or disclosure of their personal information will be directed to the Privacy Officerabove.