Your Personal Information
If you receive an email from us, it will be bec/ you have opted in to our email list. We promise to keep your email address secure and private and will not allow anyone else to use it.
1. In accordance with HIPPA, your information may only be released with your consent.
2. Your demographic information as well as diagnosis is used in secure electronic billing. Billing staff is informed of dates of service, diagnosis, your demographic information, and health insurance information. For clients who chose to file insurance claims, please be aware that in order for you to be reimbursed by your health care company, I will be required to diagnose a mental health condition. Any diagnosis made may become part of your medical / insurance record.
3. All of our sessions will become part of your clinical record. Our communication is privileged. I will keep confidential anything you say to me, with the following exceptions: 1) you authorize me to tell someone else, as in the case with insurance reimbursement, or consultation with another professionals, 2) I am ordered by the court to disclose your information, 3) I determine that you are a danger to yourself or to others, 4) If during session I become aware that there is physical abuse, sexual abuse, or neglect to a child or an aged adult, I am required to report to the State of Texas Protective Services. 5) I must also disclose to the proper authorities if there has been sexual abuse perpetrated by a minister or therapist, or if there has been a life threatening felony unreported. I keep your client file in dual locked storage.
4. I maintain records for a period of seven years for adults an seven years beyond the age of 18 for children. All electronic data is password protected.
5. When requesting additional authorizations from your insurance company (particularly HMO’S) I will be required in most cases to support my request with clinical information.
6. To ensure that I am providing quality of care, insurance companies may from time to time audit me. In the event of this, an agent of the insurance company may request access to your chart to ensure that essential paperwork is enclosed such as initial assessment, visit log, demographic information, client contract, explanation of confidentiality, treatment plan and discharge notes.
7. I may hire a medical or other professional to audit charts to prepare for such mentioned audits and or to provide support services as needed. No other Quality Improvement etc will be performed on your file, by anyone other than me. Any business agent such as a medical billing service, medical secretary, or auditor are bound to strict confidentiality and are punishable by law for any infringement upon confidentiality clauses.
Patient Rights and Responsibilities
We recognize that you are an individual with unique needs and perspectives. The following reflects your rights and responsibilities as we partner with you to provide your care.
You have a right to:
- Receive considerate and respectful care.
- Receive private and confidential care.
- Know who is responsible for coordinating your care.
- Ask for and receive complete and understandable information about your condition and care.
- Participate in decisions regarding your care.
- Request assistance for concerns and receive a response from your therapist.
- Refuse treatment.
- Access your medical records.
- Receive an explanation of your bill.
- Receive respect for your cultural and spiritual beliefs.
Voice concerns to without fear of reprisal or discrimination. Call 972-596-1805 and speak to one of our Patient Relations Coordinators to voice concerns or answer questions.
You have a responsibility to:
- Provide complete and accurate health, medical and insurance information.
- Ask questions when you are in doubt.
- Communicate changes in your health and/or condition to your caregivers.
- Pay your therapy bill promptly.
- Follow your caregivers' instructions or discuss with them any obstacles you may have in complying with your treatment plan.
- Accept responsibility for refusing treatment or not following your treatment plan.
- Show consideration for others around you, including other patients and staff.
- Follow all clinic rules affecting patient conduct and care.