TrueCare24 Informed Consent for Outpatient Services contract

DISCLOSURE STATEMENT

This statement is being provided to you by Truecare24 and its business associates, so that you are aware of your rights as a patient. This document contains important information about Truecare24 and its business associates’ policies as well as counseling sessions. Please read this and discuss any questions or concerns you have with your healthcare professional. Your provider’s license, qualifications, and contact information are listed at the end of this document.

YOUR RIGHTS AS A PATIENT

Except in an emergency situation, or where psychotherapy is being administered pursuant to a court order, every Licensed Psychotherapist, Licensed Social Worker, Licensed Mental Health Counselor, unlicensed psychotherapist,or psychologist shall provide the information below in writing to each client at the initiation of therapy.

Please see Addendum (1) for state specific general responsibility of regulating the practice of licensed psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, licensed school psychologists practicing outside the school setting and unlicensed individuals who practice psychotherapy.

Importantly, you have the right to receive evidenced based medical care and professional services from your counselor. Your counselor aims to provide services in a professional and ethical manner within accepted legal standards. If you are ever dissatisfied with your therapy, please directly discuss these concerns with your counselor. If they are not able to resolve these issues you may report complaints to the [email protected]

You are entitled to receive information about methods of therapy, the techniques used, the duration of your therapy (if it can be determined), and fee structure. You may seek a second opinion from another therapist and you can terminate services at any time. Your therapist may refer you to another provider if the issues brought up during your sessions are outside of the scope of practice, or beyond their training, experience and/or competence.

In a professional relationship (such as between you and your therapist), sexual intimacy between a therapist and a client is never appropriate. If you believe your provider is compromising his/her relationship between you (the patient) and them (the provider) through inappropriate sexual advances, innuendos, or any other direct or indirect action please notify TrueCare24 compliance and the State Board of Examiners of Professional Counselors in your state, it should be reported to the appropriate State Board of Examiners of Professional Counselors.

Psychological Services

Psychotherapy is not easily described in general statements. It varies depending on the particular problems you hope to address. There are many different methods your therapist may use to deal with those problems. Psychotherapy is not like a medical doctor visit. Instead, it requires active participation on your part. In order for the therapy to be successful, you will have to work on things you talk about in and out of therapy.

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. On the other hand, psychotherapy has also been shown to have immense benefits for people who go through the process.. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress..

You will be assigned a primary therapist but may be seen by an interim therapist to ensure continuity of care.Your first few sessions will involve an evaluation of your needs. By the end of the evaluation, your therapist will be able to offer you some first impressions of what your treatment plan will include, if you decide to continue with therapy. You should evaluate this information along with your own opinions about whether you feel comfortable working with your therapist. At the end of the evaluation, your therapist will notify you if he or she believes that they are not the right therapist for you and, if so, will give you referrals to other practitioners whom he or she believes are better suited to help you and your situation.

If you have questions about your therapist’s procedures, you should discuss them whenever they arise. If your doubts persist, a TrueCare24 liaison can help you find another therapist that may fit your needs better. Your therapist will normally conduct an initial evaluation that may last a couple of sessions. During this time, a decision can be made if your therapist is the best person to provide the services you need in order to meet your treatment goals. If you agree to begin psychotherapy, your therapist will schedule 30 minutes to 1 hour therapy sessions weekly, although some sessions may be longer or more frequent. To provide continuity of care in the event your primary assigned therapist is not available you may be seen by another qualified therapist employed by Truecare24

Contacting Your Therapist

Truecare24 and its business associates do not provide emergency psychiatric services, if you are experiencing a behavioral health crisis please call 911 or go to the nearest emergency room for help. For all non-emergent issues please leave a voicemail with your provider’s answering service. Your provider will try to contact you within 72 hours depending on their availability.You may contact Truecare24 and its business associates to connect you with your therapist at [email protected] or (240) 434-0963. If you are difficult to reach, please inform Truecare24 and its business associates of some times when you will be available. If you are unable to reach your therapist and feel that you cannot wait, contact your family physician or the nearest emergency room. If your primary assigned therapist will be unavailable for an extended time, Truecare24 and its business associates will provide you an interim therapist, if necessary.

Insurance Reimbursement

If you have a health insurance policy including Medicare or Medicaid, it will usually provide some coverage for mental health treatment. It is very important that you find out exactly what mental health services your insurance policy covers.

You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, please call your plan administrator.

You should also be aware that most insurance companies require that your therapist provide them with your clinical diagnosis. Sometimes your insurance company may ask Truecare24 and its business associates to provide additional clinical information, such as treatment plans, progress notes or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files.,. In some cases, they may share the information with a national medical information database. Truecare24 and its business associates will provide you with a copy of any records we submit. You understand that, by using your insurance, you authorize Truecare24 and its business associates to release such information to your insurance company. Truecare24 and its business associates will only share information that is required by your insurance company and will respect and abide by HIPAA per your insurance companies agreed upon requirements.

Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you feel ready to end your sessions. It is important to note that you always have the ability to pay for TrueCare behavioral health services out of pocket to to avoid disclosing this to your insurance company and possibly having your insurance company request these reports. [unless prohibited by the insurance contract].

ELECTRONIC COMMUNICATION POLICY

Electronic Communication Policy

Introduction

In order to maintain clarity regarding Truecare24 and its business associates’ this policy exists to provide guidelines and expectations regarding communication between you (the patient) and the mental health provider. This is because the use of various types of electronic communications is common in our society, and many individuals believe this is the preferred method of communication with others, whether their relationships are social or professional. Many of these common modes of communication, however, put your privacy at risk and can be inconsistent with the law and with the standards of your therapist’s profession. Consequently, this policy has been prepared to ensure the security and confidentiality of your treatment and to be HIIPPA compliant . If you have any questions about this policy, please feel free to discuss this with your therapist.

EMAIL COMMUNICATIONS

Truecare24 and its business associates use email communication and text messaging only with your permission, and only for administrative purposes.. That means that email exchanges and text messages with Truecare24 and its business associates should be limited to things like setting and changing appointments, billing matters and other related issues. Please do not email Truecare and its business associates about clinical matters because email is not a secure way to send protected health information (PHI) to Truecare24 and its business associates. If you need to discuss a clinical matter with your therapist please feel free to call Truecare24 and its business associates so we can discuss it on the phone or during your therapy session. The telephone or face-to-face context is a more protected means for these communications.

Text Messaging

Text messaging is a unsafe and impersonal mode of communication in regards to discussing your medical care. Truecare24 and its business associates do not permit therapists to text message or respond to text messages from clients in treatment. .

SOCIAL MEDIA

Therapists employed by Truecare24 and its business associates do not communicate with, or contact, any clients through social media platforms like Twitter, instagram, TikTok, LinkedIn, Facebook, etc.. In addition, if Truecare24 and its business associates discover that your therapist has accidentally established an online relationship with you, Truecare24 and its business associates will ask that the provider terminate that relationship.

Therapists employed by Truecare24 and its business associates may participate on various social networks, but not in any professional capacity. If you have an online presence, there is a possibility that you may encounter your therapist. If that occurs, please discuss it with your therapist or during your scheduled session. Truecare24 and its business associates believe that any communications with clients online have a high potential to compromise the professional relationship. In addition, please do not try to contact your therapist, or Truecare24 and its business associates in this way. Your therapist will not respond and will terminate any online contact no matter how accidental.

WEBSITES

Truecare24 and its business associates have a website that you are free to access. It is used for professional reasons to provide information to others about Truecare24 and its business associates and services provided. You are welcome to access and review the information that Truecare24 and its business associates have on its

WEB SEARCHES

Your therapist employed by Truecare24 and its business associates will not use web searches to gather information about you without your permission. Truecare24 and its business associates believe that this violates your privacy rights; however, we understand that you might choose to gather information about Truecare24 and its business associates in this way. In this day and age there is an incredible amount of information available about individuals on the internet, much of which may actually be known to that person and some of which may be inaccurate or unknown. If you encounter any information about Truecare24 and its business associates, your therapist through web searches, or in any other fashion for that matter, please discuss this with your therapist during your time together so that we can deal with it and its potential impact on your treatment.

We discourage patients from reviewing their providers on websites like yelp, google and other subjective evaluating websites. mental health professionals cannot respond to such comments as this would violate HIPPA and your privacy. If you encounter such reviews of Truecare24 and its business associates or any professional with whom you are working, please share it with Truecare24 and its business associates so we can discuss it and its potential impact on your therapy.

PROFESSIONAL RECORDS

Laws and standards require that your personal Protected Health information are kept secure in your clinical record. Except in unusual circumstances that involve danger to yourself and/or others, you may examine and/or receive a copy of your clinical record if you request it in writing to Truecare24 and its business associates. Your therapist will keep very brief records, noting only that you were seen, what interventions were implemented, and progress toward treatment goals. Truecare24 and its business associates will maintain your clinical records in a secure location. Your records will be destroyed after the termination of your treatment if it is required by law within required by law timeframe.