Cheaha Counseling and Consulting LLC
1323 Hamric Dr East
HIPAA Notice of Privacy Practices and Informed Consent
Revised: March 13, 2015
Client Rights: As a client of Cheaha Counseling and Consulting, you have the right: to be treated with respect and dignity and in a culturally sensitive manner; to be provided assistance with any communication barriers which make it difficult for you to receive services; to be free from discrimination while receiving services; to terminate services at any time; to be free from exploitation for the benefit of staff; to report complaints/grievance; to confidentiality as defined by policy and law. Cheaha Counseling and Consulting maintains a strict policy on the confidentiality of your records (written and electronic). All information you share, or what we become aware of through our work with you will remain confidential. There are some circumstances in which this policy becomes void, and Staff is required by law to release information: if we become aware through our work that you may be a danger to yourself or others; if we become aware of or suspect child abuse or neglect; if we become aware of or suspect abuse or neglect to a vulnerable adult; if we are court ordered to testify or to submit records for court; in the above situations (a-d), I would be required to inform the appropriate authorities.
Informed Consent: Counseling is a collaborative process between you and a counselor to work on areas of dissatisfaction in your life and assist you with life goals. For counseling to be most effective, it is important that you take an active role in the process. Counseling activities are governed by the Alabama State Board of Examiners for Professional Counselors. Cheaha Counseling and Consulting does not take on clients we do not think we can help. Therefore, we will enter our relationship with optimism about our progress.
Time Parameters: Individual appointments are typically scheduled for 50 minute segments, unless set otherwise by client and treatment provider. Being late for an appointment by 15 minutes or more may require that you reschedule. Fees will still be due and charged to your credit card, or you will be billed.
Credentials: All credentials of our counselors are listed on our website and displayed in the office. We have master level counselors and social workers on staff. Associate Licensed Counselors, Licensed Professional Counselors, and master level graduate interns may be providing counseling services. All counselors are independent contractors.
Confidentiality: As Mental Health Providers in the State of Alabama, we abide by the ACA Code of Ethics. In accordance with these rules, information obtained in the session or in written form will not be disclosed to any outside person(s) of Cheaha Counseling and Consulting LLC or another agency without your written permission, except when such disclosure is necessary to “protect you or someone else from imminent harm” or is otherwise legally required and/or allowed by law (such as abuse of a child, elder or disabled person or court order). If you are under 14, your parents or legal guardian(s) may have access to your records and may authorize release to other parties. Furthermore, if you want your EAP or insurance to pay for all or part of your treatment, we must be able to discuss your diagnosis and treatment with their representative.
Risks: In counseling and many other services we provide, major life decisions are sometimes made, including decisions involving separation within families, development of other types of relationships, changing employment settings and changing lifestyles. The decisions are a legitimate outcome of the counseling experience as a result of an individual’s calling into question many of their beliefs and values. Furthermore, symptoms may be intensified and the emotional experience may be too intense to deal with at this time. We will be available to discuss any of your assumptions or possible negative side effects in our work together.
Electronic Transmission: We cannot ensure the confidentiality of any form of communication through electronic media. You are advised that any email sent to Cheaha Counseling and Consulting LLC via a computer in a work-place environment is legally accessible by an employer. Counseling concerns cannot be discussed through text messaging or email transmission. Counseling can only be completed over the phone (if scheduled as an appointment) or in the office.
Social Media: It is our policy to not connect with our clients through personal social media (such as Facebook, Twitter, MySpace, etc). Our Counselors will not be able to accept any personal request to “friend” or “follow” you from these sites.
Records: We are required by law to maintain records of each time we meet or talk on the phone. These records include a brief synopsis of the conversation along with any observations or plans for the next meeting. A judge can subpoena your records for a variety of reasons, and if this happens, we must comply. We can be called to testify about the contents of the records and we must comply. Also, in order to file for insurance reimbursement, CCC will have to assign you a diagnosis. If you have any questions about this, please let us know. We will certainly share any information with you that we provide to an insurance provider. You have a right to inspect and copy records but the counselor may deny your request. There is a fee for copying and mailing of records. This fee is determined by the size of your record. Your records will be maintained for 7 years for adults and 10 years for children. After this time, your record will be shredded and disposed of. Records are maintained and stored using HIPAA compliant Therapy Appointment services.
Transfer Plan for Counselor Incapacitation or Termination of Practice: In the event Cheaha Counseling and Consulting LLC is unable to provide ongoing services (due to death or incapacitation), Cheaha Counseling and Consulting will provide those services or will refer you to the appropriate resource. CCC will maintain your records for a period of 7 years (10 years after case closes if under 18 years of age). In this situation, the custodian of records may be contacted at 1-256-430-5183. If custodian of records is to change, you will be notified by letter.
Consultation and Supervision: Information about you may be discussed in confidence, with other counseling professionals on the treatment team for Cheaha Counseling and Consulting for the purpose of consultation and providing you the best possible service.
Fees and Payment: Payment will be collected at the time of service or beforehand if paying by credit card. Cash rates are available. Cash, money orders, and most major credit cards are accepted. We do accept some insurances but client is responsible for co-pay before services are rendered. If you do not provide 24 hour notice of cancellation, you will be charged the FULL COST of the session. You will be held responsible for this payment, not your insurance company.
Court/State Requirements: If you are seeking counseling services (individual or group) due to a recommendation for a court official, it is your responsibility to make sure that our services meet requirements of the referral agency. We are more than happy to provide you with documentation needed. Services are non-refundable.
Appointment Reminders/Cancellation: Appointment reminders can be sent by phone, email, or text. Please specify on the demographic sheet how we may contact you. If you find it necessary to cancel an appointment, please contact your counselor at 256-403-5183 at least 24 hours in advance. Cancellations with less than 24 hours advance notice will be charged full cost of session. The provider may also terminate counseling services and refer to another agency in the event the client has missed 3 appointments without calling to cancel 24 hours prior to the scheduled appointment.
Emergencies: If an emergency situation for which you feel immediate attention is necessary, please contact emergency services (911) immediately or go to your nearest hospital emergency room. You can also call the crisis hotline at -1800-273-8255.We will follow those emergency services with standard counseling and you may call our office at 256-403-5183– please indicate if a call is an emergency or if it is urgent, otherwise calls are returned during normal business hours.
Cheaha Counseling and Consulting Expectations: As Cheaha Counseling and Consulting provides services, it is expected: that the client will present and on time for appointment, or will call in advance and cancel or reschedule; that clients will participate in service planning; that clients will not exhibit abusive, threatening, or assault behaviors; that clients will not be under the influence of chemicals during services. Cheaha Counseling and Consulting reserves the right to deny services and make referrals to other agencies based on the above criteria.