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Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Client Information

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( If client is a minor, the legal guardian must enter their email address below. )



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( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

HIPPA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.                                                                                                  


Information will only be released in accordance with state and federal laws and the ethics of the counseling profession.

This notice describes policies related to the use and disclosure of your, the client's, healthcare information.

Use and disclosure of protected health information for the purposes of providing services. Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes.

The use and disclosure of health information may be needed for TREATMENT to provide, manage or coordinate care, consult with other healthcare professionals and to communicate with referral sources.

For example, information may be shared with providers to create a treatment plan specifically to meet your needs.

The use and disclosure of health information may be needed for PAYMENT to verify insurance/ coverage and to process claims and collect fees.  For example, information may be shared with Blue Cross/ Blue Shield to cover services rendered.

The use and disclosure of health information may be needed for HEALTHCARE OPERATIONS to review treatment procedures and business activities, certification, training, and compliance and licensing activities.  For example, staffing with another LPC may occur to explore treatment options.

The use and disclosure of health information may be needed for OTHER USES AND DISCLOSURES WITHOUT YOUR CONSENT such as mandated reporting, emergencies, criminal damage, appointment scheduling, treatment alternatives and as required by law.  For example, if a child is being physically abused, as a mandated reporter, the authorities must be contacted.


CLIENT RIGHTS

The following is to inform you, the client, as to your rights under state and federal law.

1. You have the right to request where I contact you (ex: home, work, cell phone or any other means you prefer).  This information was identified in your initial intake.  You maintain the right to change this at any time.

2. You have the right to request the release of your medical records.

  a. In order for you records to be released, you will need to provide written authorization to release the records (ex: changing to a new counselor for therapeutic services).

b. You have the right to revoke this release by submitting a written request

c. Revocation is not valid to the extent that you have acted in reliance on such previous authorization.  In other words, information disclosed with the release cannot be undone with revocation.

3. For example, your counselor may want to consult with your physician in regards to medication management.

4. You maintain the right to inspect and copy your medical billing records.  In most cases, you maintain the right to review or request copies of you records.  You may be charged for the costs associated such as copying and/ or mailing.

5. You have the right to add information or amend you medical records.  You may request to amend your record in writing, and provide a reason for your request.  While the counselor may deny this request, you have the right to file a disagreement statement.  Your disagreement statement and response will be filed in the record.  Any amendment request must be in writing.

6. You have the right to accounting of disclosures for a 6 year period beginning with the date January 2012.  Exceptions include:

a. Disclosure for treatment, payment or healthcare operations

b. Disclosures pursuant to a signed release

c. Disclosure made to client

d. Disclosures for national security or law enforcement

7. You maintain the right to request restrictions on uses and disclosures of your healthcare information.  In other words, you have the right to request to limit how your information is used or disclosed.  This request must be in writing and you must identify what information you want to limit and to whom you want the limits to apply.  You can request in writing for the limit to be terminated.  The counselor is not obligated to agree.

8. You maintain the right to complain.  Please contact your counselor, Dr. Kalvin DeHart, DPC, LPC-S, NCC, first to discuss; however, if you are not satisfied, you have the right to complain to the U.S. Dept. of Health and Human Services.  If you file a complaint, you maintain the right for no retaliation by your counselor.

9. You maintain the right to receive a notice of changes of policy that affect you on or after the effective date of change.

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