Psychotherapy Notes Sample Clauses

Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
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Psychotherapy Notes. We maintain psychotherapy notes separately from the remainder of our records. Use or disclosure of these notes will occur only under these circumstances: (a) you specifically authorize their use or disclosure in a separate written authorization; (b) the therapist who wrote the notes uses them for your treatment; (c) we may use them for our own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; (d) if you bring a legal action and we have to defend ourselves; and (e) certain limited circumstances defined by law.
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Psychotherapy Notes. In general, we will not use or disclose psychotherapy notes (notes recorded by a mental health professional to document or analyze conversations with you and/or your family and stored separately from your medical record), unless you authorize us to do so. However, we can use or disclose such protected health information without your authorization for the following purposes: (1) the health professional who recorded the information can use it to treat you; (2) in limited situations, Lifespan can use or disclose the information in connection with mental health counseling training that occurs at Lifespan; and (3) Lifespan can use a patient’s psychotherapy notes to defend against any legal proceeding brought by a patient.
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Psychotherapy Notes. In addition, we also keep a set of Psychotherapy Notes. These notes are for our own use and are designed to assist us in providing you with the best treatment. While the contents of Psychotherapy Notes vary from client to client, they can include the contents of our conversations, our analysis of those conversations, and how they impact on your therapy. They also contain particularly sensitive information that you may reveal to your clinician that is not required to be included in your Clinical Record. These Psychotherapy Notes are kept separate from your Clinical Record. While insurance companies can request and receive a copy of your Clinical Record, they cannot receive a copy of your Psychotherapy Notes without your signed written authorization. Insurance companies cannot require your authorization as a condition of coverage nor penalize you in a way for your refusal. You may examine and/or receive a copy of your Psychotherapy Notes unless your clinician determines that release would be harmful to your physical, mental, or emotional health.
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Psychotherapy Notes. Notes recorded by your clinician documenting the contents of a counseling session with you ("Psychotherapy Notes") will be used only by your clinician and will not otherwise be used or disclosed without your written authorization.
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Psychotherapy Notes. This may include the contents of our conversations, my analysis of those conversations, and how they impact on your therapy. They also contain particularly sensitive information that you may reveal to me that is not required to be included in your Clinical Record. These notes cannot be sent to anyone else, and although I am not required to release them to you, I will usually be glad to consider doing this unless I feel it will negatively impact therapeutic progress. PATIENT RIGHTS You have the right: To decide not to receive psychotherapy from me. If you wish, I can provide you with the names and phone numbers of other qualified mental health professionals. To end therapy at any time without any moral or legal obligations or without incurring any further financial obligations. To ask questions about the procedures used during therapy, the approximate duration of therapy (if it can be determined) and the fee structure and policies I use. To prevent the use of certain therapeutic techniques. I shall inform you if I intend to use any unusual procedures and shall describe any risks involved. To request that I amend your record, that I restrict what information is disclosed from your Clinical Record to others, that an accounting of such disclosure occur, that any complains you make about my policies and procedures are recorded in your record, and to request a copy of this Agreement and the attached Notice form. To prevent electronic recording of any part of the therapy session; permission to record must be granted by you in writing explaining the purpose for the recording and for what time period the recording will take place. You have the right to withdraw your permission to record at any time. To avoid dual relationships with your psychologist. The relationship with your psychologist should remain strictly professional. In this regard, it is unethical and illegal for a psychologist to engage in any sexual behavior with any client, at any time. If any sexual behavior occurs, a written complaint should be sent to The Colorado State Board of Psychological Examiners or a phone call can be made to that agency. The address, phone number and website for that agency are listed elsewhere in this Agreement. MINORS & PARENTS Patients under 15 years of age who are not emancipated and their parents should be aware that the law may allow parents to examine their child’s Clinical Records, unless I decide that such access is likely to be harmful to the child. Because privacy...
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Psychotherapy Notes. These Notes are for my own use and are designed to assist me in providing your child and/or family with the best treatment. While the contents of Psychotherapy Notes vary from client to client, they can include the contents of our conversations, my analysis of those conversations, and how they impact therapy. They also contain particularly sensitive information that you, your child, and/or your family may reveal to me that is not required to be included in your Clinical Record. These Psychotherapy Notes would be kept separate from your Clinical Record. Your Psychotherapy Notes are not available to you and can not be sent to anyone else, including insurance companies, without your written, signed Authorization. Insurance companies cannot require your Authorization as a condition of coverage nor penalize you in any way for your refusal to provide it. MINORS & PARENTS The law allows parents of unemancipated patients under 18 to examine their child's clinical record unless I decide that such access is likely to injure the child, or we agree otherwise. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes my policy to request an agreement from parents that they consent to give up their access to their child's records. If they agree, during treatment, I will provide them only, at the parent's request, with general information about the progress of the child's treatment, and his/her attendance at scheduled sessions. If requested in writing, I will also provide parents with a summary of their child's treatment when it is complete. Any other communication will require the child's Authorization, unless I feel that the child is in danger or is a danger to someone else, in which case, I will notify the parents of my concern. Before giving parents any information, I will discuss the matter with the child, if possible, and do my best to handle any objections he/she may have. LIMITS ON CONFIDENTIALITY The law protects the privacy of all communication between a patient and a psychologist. In most situations, I can only release information about your child and/or family's treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written advance consent. Your signature on this Agreement provides consent for those activities, as follows: ➢ I may occasionally find it helpful to consult other h...
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Related to Psychotherapy Notes

  • PSYCHOLOGICAL SERVICES Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you hope to address. There are many different methods I may use to deal with those problems. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home. Psychotherapy can have benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. When treating insomnia specifically, therapy might cause you to experience increased sleepiness and fatigue, especially in the early phases of treatment. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, significant reductions in feelings of distress, improved sleep, and less fatigue. But there are no guarantees as to what you will experience. Our first session will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with me for therapy. You should evaluate this information along with your own opinions about whether you feel comfortable working with me. At the end of the evaluation, I will notify you if I believe that I am not the right therapist for you and if so, I will give you referrals to other practitioners who I believe are better suited to help you. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion. Please note that the psychological services I provide are not for emergency situations. For emergencies, call 911 or go to the nearest emergency room. FEES My fee is $395 for an initial evaluation lasting 90 minutes, and $250 for each subsequent psychotherapy session (either in-person or over the telephone) lasting 45 minutes. I charge this same $250 per 45-minutes rate for other professional services you may need, though I will prorate the cost if I work for periods of less than 45 minutes in increments of 15 minutes, rounded to the nearest 15-minute increment (e.g., 22 minutes of service will be charged for 15 minutes whereas 23 minutes of service will be charged for 30 minutes). Other professional services include telephone conversations or email responses lasting longer than 15 minutes, and the time spent performing any other service you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for any professional time I spend on your legal matter, even if the request comes from another party, at the same $250 per 45-minutes rate. I do not charge for time spent writing reports and progress notes as per the standard routine of my care of you. I also do not charge for any time I may spend collaborating with your other providers. From time to time, I may institute fee increases and these will be discussed and agreed upon ahead of time with a new Treatment Contract. If it has been more than one year since our last appointment, then you will re-initiate services at my current standard fee which may be higher than the fee you were previously paying. In addition, if it has been more than one year since our last appointment, you will be scheduled for another initial evaluation (90 minutes) and charged accordingly, with subsequent 45-minute psychotherapy sessions thereafter. INSURANCE REIMBURSEMENT You are responsible for paying your full session fee. I am not in-network with any insurance companies. If you decide to submit claims to your insurance company for reimbursement for any out-of-network benefits you might have, you may do so. However, be aware that the services provided will still be charged to you, not your insurance company, and you are responsible for the full payment. I have no role in deciding what your insurance covers. You are responsible for checking your insurance coverage, deductibles, payment rates, pre-authorization procedures, etc. Missed appointments, late cancellations (i.e., cancellations within 24 hours of service), and telephone session are not typically covered by insurance companies and therefore you will likely be responsible for the full session fee in these instances. If your insurance company doesn’t reimburse you, I am not responsible for refunding you any payment you expected to be reimbursed or otherwise. I will provide you a superbill after each session with the following information that you will need to submit to your insurance company for reimbursement for any out-of-network benefits you might have:

  • Psychotherapist-Patient Privilege The information disclosed by Patient, as well as any records created, is subject to the psychotherapist-patient privilege. The psychotherapist-patient privilege results from the special relationship between Therapist and Patient in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient privilege. Typi- cally, the patient is the holder of the psychotherapist-patient privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-patient privilege on Patient’s behalf until instructed, in writing, to do otherwise by Patient or Patient’s representative. Patient should be aware that he/she might be waiving the psychotherapist-patient privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Patient should address any concerns he/she might have regarding the psychotherapist-patient privilege with his/her attorney. Fee and Fee Arrangements The usual and customary fee for service is $100.00 per 50-minute session. Sessions longer than 50-minutes are charged for the additional time pro rata. Therapist reserve the right to periodically adjust this fee. Patient will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with in- surance companies, managed care organizations, or other third-party payers, or by agreement with Therapist. From time-to-time, Therapist may engage in telephone contact with Patient for purposes other than sched- uling sessions. Patient is responsible for payment of the agreed upon fee (on a pro rata basis) for any tele- phone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone con- tact with third parties at Patient’s request and with Patient’s advance written authorization. Patient is respon- sible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Patients are expected to pay for services at the time services are rendered. Therapist accepts cash, or major credit cards.

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