Informed Consent Policy
Questions:
Sessions cannot begin without your consent and understanding of the therepeutic process.
N.H. Admin. Code § Mhp 502.02 – Mental Health Bill of Rights
NH
Notice of Privacy Practices
What is Considered Private?
All of your disclosed information within sessions shall remain private and confidential.
The ONLY breach of confedentiality is if you disclose immenent risk to harm self or others. Clients are encouraged to share thoughts openly without fearing reprocussions. I value transparency across sessions while also valuing your and other’s safety.
HIPPA Release of Information (ROI) Policy
What is considered Private?
All of your disclosed information within sessions shall remain private and confidential.
A (ROI) Form is used if you want your information disclosed to a particular third-party. ex: guardians, medical team collaboration, programs
ROI’s and their limits will be discussed in sessions. Only direct, practical and relevant information will be shared based on your needs. e.g a typical collaboration lasts 5-10 minutes
Attendance and Cancelation Policy
What are Attendence Guidelines?
Attendance and participation are valued to ensure productive sessions.
Informed Cancelations: Let me know the day before (within 24 hours) of your session to avoid a cancelation fee
NoCall NoShow NCNS: When you do not let me know of an absence. A cancelation fee will be charged.
Contact Policy
&
Scheduling
When can you reach me?
I have a complex schedule and only have time to reply in the morning -before 10am and in the evening – after 7pm
I will respond to all other contacts when time becomes avalible. (ex: client cancelations)
I am in sessions across each week-day and will not awnser phonecalls or text messages.
Email is prefered contact to ensure confidentiality and a coherent record of interactions
Payment Authorization Form
How Do I Pay?
I do not accept insurance plans at this time
This form outlines rationale for why I consider Self-Pay optimal for the therapy process.
Session Review / Treatment Planning
Policy
What documents do I recieve from Sessions?
I value your time and progress across sessions and will periodically review diagnostic criteria.
You will be given your Diagnostic Outline on your first-day Diagnostic Review on your third-day Diagnostic Update on your third-month from there, Progress reviews every six months
- I will only write specific referals after three months of active engagment