All contact is held in confidence. The therapeutic relationship is
considered a privileged relationship. Essentially this means I will not
disclose anything that goes on in our sessions, nor the fact of your being
my client, with a few exceptions. By law I am required to disclose critical
information if I suspect abuse of a minor or elder, if you are about to
actually commit suicide, or if you are seriously threatening a known person
or property. I can also be required to breach confidentiality if ordered by
a judge in a court of law. If you have any concerns or questions regarding
this issue I am happy to discuss it in more detail with you.
24 Hour cancellation:
You may cancel an appointment at any time. If it is within 24 hours of
our appointment I will expect payment for that session.
Sessions are $125. Sessions are each 50 minutes, unless we arrange for a
longer session. Payment is to be brought to each session unless we make an
alternate agreement. I accept both cash and checks. I recommend having
payment ready prior to our session so as to avoid using our therapy time
writing out a check.
I am a preferred provider with a number of insurance carriers. Contact
me to discuss what insurance I am currently accepting. If I am not a preferred
provider for your plan or you wish to use flexible spending funds, you can
pay me directly and seek reimbursement from your insurance carrier or
access your flexible spending funds. I can provide a statement for you to
facilitate this process.
Diverse sexual and lifestyle choices are welcome. I invite you to share
who you are in our work together.
I expect clients to attend sessions sober as this will best facilitate
our work together.
Notice of Privacy Practices:
I. This notice describes how
medical information about you may be used and disclosed and how you can get
access to this information. Please review it carefully.
II. I have a legal duty to
safeguard your protected health information (PHI)
legally required to protect the privacy of your PHI, which includes
information that can be used to identify you that I've created or received
about your past, present, or future health or condition, the provision of
health care to you, or the payment of this health care. I must provide you
with this Notice about my privacy practices, and such Notice must explain
how, when, and why I will “use” and “disclose” your
PHI. A “use” of PHI occurs when I share, examine, utilize,
apply, or analyze such information within my practice; PHI is
“disclosed” when it is released, transferred, has been given
to, or is otherwise divulged to a third party outside of my
practice. With some exceptions, I may not use or disclose any more of your PHI
than is necessary to accomplish the purpose for which the use or disclosure
is made. And, I am legally required to follow the privacy practices
described in this Notice.
reserve the right to change the terms of this Notice and my privacy policies
at any time. Any changes will apply to PHI on file with me already. Before
I make any important changes to my policies, I will promptly change this
Notice and post a new copy of it on my website: www.PersonalChange.org. You can also
request a copy of this Notice from me.
III. How I may use and disclose your PHI.
I will use
and disclose your PHI for many different reasons. For some of these uses or
disclosures, I will need your prior written authorization; for others,
however, I do not. Listed below are the different categories of my uses and
disclosures along with some examples of each category.
A. Uses and Disclosures
Relating to Treatment, Payment, or Health Care Operations Do Not Require
Your Prior Written Consent.
I can use
and disclose your PHI without your consent for the following
3. For Health Care Operations. I can use and disclose your PHI to
operate my practice. For example, I may provide your PHI to my accountant,
attorney, consultants, or others to further my health care operations.
4. Patient Incapacitation or Emergency. I may also disclose your
PHI to others with-out your consent if you are incapacitated or if an
emergency exists. For example, your consent isn't required if you need
emergency treatment, as long as I try to get your consent after treatment
is rendered, or if I try to get your consent but you are unable to
communicate with me (for example, if you are unconscious or in severe pain)
and I think that you would consent to such treatment if you were able to do
B. Certain Other Uses and Disclosures Also Do Not Require Your Consent
or Authorization. I can use and disclose your PHI without your consent
or authorization for the following reasons:
1. When federal, state, or local laws require disclosure. For
example, I may have to make a disclosure to applicable governmental
officials when a law requires me to report information to government
agencies and law enforcement personnel about victims of abuse or neglect.
2. When judicial or administrative proceedings require disclosure.
For example, if you are involved in a lawsuit or a claim for workers’
compensation benefits, I may have to use or disclose your PHI in response
to a court or administrative order. I may also have to use or disclose your
PHI in response to a subpoena.
3. When law enforcement requires disclosure. For example, I may
have to use or disclose your PHI in response to a search warrant.
4. When public health activities require disclosure. For example,
I may have to use or disclose your PHI to report to a government official
an adverse reaction that you have to a medication.
6. To avert a serious threat to health or safety. For example, I
may have to use or disclose your PHI to avert a serious threat to the
health or safety of others. However, any such disclosures will only be made
to someone able to prevent the threatened harm from occurring.
7. For specialized government functions. If you are in the
military, I may have to use or disclose your PHI for national security
purposes, including protecting the President of the United States or conducting
8. To remind you about appointments and to inform you of
health-related benefits or services. For example, I may have to use or
disclose your PHI to remind you about your appointments, or to give you
information about treatment alternatives, or other health care services.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to Family, Friends, or Others. I may provide your
PHI to a family member, friend, or other person that you indicate is involved
in your care or the payment for your health care, unless you object in
whole or in part. The opportunity to consent may be obtained retroactively
in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization.
In any other situation not described in sections III A, B, and C above, I
will need your written authorization before using or disclosing any of your
PHI. If you choose to sign an authorization to disclose your PHI, you can
later revoke such authorization in writing to stop any future uses and
disclosures (to the extent that I haven't taken any action in reliance on
such authorization) of your PHI by me.
IV. What rights
you have regarding your PHI
You have the following
rights with respect to your PHI:
C. The Right to Inspect and Copy of Your PHI. In most cases, you have
the right to inspect and copy the PHI that I that I have on you, but you
must make the request to inspect and copy such information in writing. If I
don't have your PHI but I know who does, I will tell you how to get it. I
will respond to your request within 30 days of receiving your written
request. In certain situations, I may deny your request. If I do, I will
tell you, in writing, my reasons for the denial and explain your right to
have my denial reviewed.
If you request copies
of your PHI, I will charge you not more than $.25 for each page. Instead of
providing the PHI you requested, I may provide you with a summary or
explanation of the PHI as long as you agree to that and to the cost in
D. The Right to Receive a List of the Disclosures I Have Made. You
have the right to receive a list of instances, i.e., an Accounting of
Disclosures, in which I have disclosed your PHI. The list will not include
disclosures made for my treatment, payment, or health care operations;
disclosures made to you; disclosures you authorized; disclosures incident
to a use or disclosure permitted or required by the federal privacy rule;
disclosures made for national security or intelligence; disclosures made to
correctional institutions or law enforcement personnel; or, disclosures
made before April 14,
I will respond to your
request for an Accounting of Disclosures within 60 days of receiving such
request. The list I will give you will include disclosures made in the last
six years unless you request a shorter time. The list will include the date
the disclosure was made, to whom the PHI was disclosed (including their
address, if known), a description of the information disclosed, and the
reason for the disclosure. I will provide the list to you at no charge, but
if you make more than one request in the same year, I may charge you a
reasonable, cost-based fee for each additional request.
F. The Right to Receive a Paper Copy of this Notice. You have the
right to receive a paper copy of this notice even if you have agreed to
receive it via e-mail.
V. How to
complain about my privacy practices:
If you think that I may
have violated your privacy rights, or you disagree with a decision I made
about access to your PHI, you may send a written complaint to the Secretary
of the Department of Health and Human Services at 200 Independence Avenue S.W., Washington,
I will take no retaliatory action against you if you file a complaint about
my privacy practices.
If you have any
questions about this notice or any complaints about my privacy practices,
or would like to know how to file a complaint with the Secretary of the
Department of Health and Human Services, please contact me, Julie Armer,
M.A., at: (415)652-6889.
date of this notice
This notice went into effect on April 14, 2003.
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Copyright © 2002-2018
Julie Armer, MA, LMFT / PersonalChange.org