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Privacy Practices

Patricia MacNair, LCSW, PLLC

Welcome to my practice. I will be continually working to provide you with appropriate, high quality services. I believe that a client who understands and participates in his/her care can achieve better results. I have the responsibility to give you the best care possible, to respect your rights, and to recognize your responsibilities as a client. I have prepared this information handout, which includes a notice of my privacy practices, to help you identify these rights and responsibilities.

Your Rights as a Client

Your Right to Privacy and Confidentiality

This notice of privacy practices describes how information I maintain about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I follow the privacy provisions of state and federal laws and rules and of my profession’s ethical standards. You have the right to know, through discussion with me and in writing, my policies and practices regarding the uses and protection of the information you will share with me and the limitations of privacy of your information. I may make changes in my policies and practices but if I do, I will inform you. Please keep a copy of this handout for your records.

The information I collect from you is needed for providing evaluation and treatment to you. I will inform you of the consequences, if any, of refusing to supply information I request. If you choose to not supply such information, I may be unable to determine which services are most appropriate for you and it will make it more difficult for me to carry out an effective treatment plan for you.

Your treatment record is accessible only to me and to personnel whom I have authorized to help me provide services to you. Your record includes your assessment, treatment plan, progress notes, psychological test reports, psychiatric and other medical reports, and closing summary.

Your billing record is also accessible only to me and to personnel whom I have authorized to perform billing services for you.

In order to further protect your privacy and confidentiality I restrict e-mail contact only to communications about scheduling of your appointment or to schedule a time for a telephone consultation. I also do not “friend” my clients or patients on social networking sites. I will accept a text only for brief notifications regarding time of your appointment such as notification that you will be late.

It is your choice whether or not to use your insurance coverage for payment of my services. I am “out-of-network” for all private insurance companies but will file your claim as a courtesy for you. If you request that I file your insurance claim, I will share only the minimum information necessary for your insurance company to process claims. I provide the following information to my billing staff for submission of claims to you and your insurance company: a) name and address of your insurance company; b) your subscriber and group plan numbers; c) your name, birth date, social security number, diagnosis, dates of service, type of service. I am a Medicare provider and will file those claims for my clients.

If your insurance company requires further information, I will first consult you about your insurance company’s request. I will give you the option to make an informed decision regarding what, if anything, you wish to be released.

All personnel—counseling, support, or billing—whom I authorize to have access to your health care information in this office will limit their access to and use of your health care information to the minimum necessary to fulfill their authorized respective functions for treatment and payment services. They have agreed to abide by the privacy and security practices of this office.

Your complete record will be retained for seven years after you have completed treatment. At the end of seven years, the record will be entirely destroyed, leaving only the name of the client and date of record destruction. The time period begins from the date of the last visit. (Or for minors, from the date they reach 18.) Should there be any further direct client contact, the counting period will begin again after the conclusion of the new service.

If you are receiving services from other health care professionals, I will need to routinely confer with them about your assessment, counseling plan, and progress for the purpose of coordinating your services.

At times I may also seek out professional consultation about some aspects of my work with you. Usually it will not be necessary to share your identifying information with the consultant(s). The consulting professional(s) also must abide by applicable laws and ethics and protect your confidentiality in all cases.

You have the right to request restrictions on personal health care information that I routinely disclose for purposes of treatment and payment. If, in my professional judgment, the restriction you request could be harmful to you (for example, prevent my ability to provide adequate services to you) I will inform you when I cannot agree to any such restriction you may request.

You have the right to an accounting of certain disclosures of your information I have made after February 2, 2010, not including disclosures for treatment, payment or health care operations, and disclosures made to you or disclosures otherwise authorized by you or by state law.

Other than the routine disclosures noted above which are necessary to perform treatment and billing services on your behalf, no information will be released to any other persons or agencies outside of this office without your written authorization except by court order. Before you give me written authorization to respond to any other requests for your health information, satisfy yourself that the information is really needed, that you understand the information being sent out, and that giving the information will help you. You have the right to approve or refuse the release of information to anyone, except as provided by law.

EXCEPTIONS to the above information release procedures are:

  • When I have knowledge of, or reasonable cause to believe, that a child or elder adult is being neglected or physically or sexually abused, in which case state law requires that such information be reported.

  • Reporting of maltreatment of vulnerable adults.

  • Reporting of alleged practitioner sexual misconduct.

  • Reporting of instances of threatened homicide or physical violence against another identified person. I must report such threats to the appropriate police agency as well to as the intended victim.

  • In cases of threatened suicide and if, in my professional judgment, your health and safety are at risk, I may contact at least one concerned person and/or the appropriate police agency to intervene and for evaluation.

Minors Right to Privacy

All non-emancipated minor clients under the age of 18 must have the consent of their parents or guardians following an initial intake session to receive further treatment services. State law provides that minors have the right to request that their records be withheld from their parents or guardians. When a minor client requests that records be withheld and/or, in my professional judgment, I determine that sharing the minor’s counseling information with parents or legal guardians is detrimental to the physical or mental health of a minor, I may refuse to release it to parents and legal guardians in order to prevent harm.

Right to Read Your Own Records and to Submit an Amendment

You have the right to inspect and request a copy of your own records,paper or electronic. All requests must be made in writing. I will assist you in understanding your records by being available to answer questions and to explain the meaning of technical terminology. I welcome your informing me of any inaccuracies of information in your file. You have the right to put in writing an amendment to the information in your file, which I will keep in your file.

Right to Know How Long I Will Retain Your Inactive Records

After you complete services, your record will be retained for seven years. At the end of seven years, the record will be entirely destroyed, leaving only the name of the client and date of record destruction. The time period begins from the date of the last visit. (Or for minors, from the date they reach 18.) Should I provide you with any further direct contact services, the counting period will begin again after conclusion of the new service.

Right to Accounting of Disclosures

Upon written request, you have the right to obtain an accounting of certain disclosures of your personal health care information, excluding those that are necessary to conduct your counseling and payment services as described above and excluding disclosures I have made to you or disclosures you have otherwise authorized.

Right to Determine Alternative Communications

You may request and I will accommodate any reasonable request for you to receive personal health care information from me by alternative means of communication or at alternative locations. For example, in order to protect your privacy, please inform me to what address you prefer that I mail billing statements or copies of records or letters and what telephone number you prefer I use.

Right Not to Be Discriminated Against

You have the right not to be discriminated against in the provision of professional services on the basis of race, age, gender, ethnic origin, disabilities creed, or sexual orientation.

Right to Know My Qualifications

You are entitled to ask me what my training is, where I received it, if I am licensed or certified, my professional competencies, experience, education, biases or attitudes, and any other relevant information that may be important to you in the provision of services. You have the right to expect that I have met the minimum qualifications of training and experience required by state law and to examine public records maintained by the North Carolina Clinical Social Work Licensing Board.

My professional competencies include the following: adult psychotherapy; couples and family psychotherapy; group psychotherapy; consultation; and supervision.

Right to Be Informed

You have the right to be informed of my assessment of your problem in language you understand and to know available counseling alternatives. You also have the right to understand the purpose of the professional services I recommend, including an estimate of the number of counseling or consultation sessions, the length of time involved, the cost of the services, the method of counseling, and the expected outcomes of counseling. You have the right and responsibility to help me develop your own counseling plan. If you are considering medication or other remedies, you have the right to be informed by your physician or other health care professional of treatment alternatives, action of the medication or remedies, and possible side effects.

Right to Refuse Services

You have the right to consent to or refuse recommended services. I can provide services to you without consent only if there is an emergency and in my opinion failure to act immediately would jeopardize your health. In such emergency cases, I will make reasonable efforts to involve a close relative or friend prior to providing emergency services. No audio or video recording of a treatment session can be made without your written permission.

Right to Voice Grievances

You have the right to voice grievances and request changes in your counseling plan without restraint, interference, coercion, discrimination or reprisal. I encourage you to share any concerns you may have with me directly at the above number, including if you believe your privacy rights have been violated. You also have the right to file a complaint about my services to the North Carolina Clinical Social Work Licensing Board at 1.800.550.7009.

Right Not to Be Subjected to Harassment

You have the right to not be subjected to harassment—sexual, physical or verbal.

Rights of Adults Judged Not Able to Give Informed Consent

For adults judged not able to give informed consent, the same policy as that for minors applies regarding permission for services and requests that records be withheld.

Referral Rights

You have the right not to be referred or terminated without explanation and notice. You have the right to active assistance from me in referring you to other appropriate services.

Your Responsibilities

As a client, you have responsibilities as well as rights. You can help yourself by being responsible in the following ways:

To Be Honest

You are responsible for being honest and direct about everything that relates to you as a client. Please tell me exactly how you feel about the things that are happening to you in your life.

To Understand Your Plan

You are responsible for understanding your counseling plan to your own satisfaction. If you do not understand, ask me. Be sure you do understand since this is important for the success of the treatment plan.

To Follow the Treatment Plan

It is your responsibility to discuss with me whether or not you think you can and/or want to follow a certain counseling plan.

To Keep Appointments

You are responsible for keeping appointments. If you cannot keep an appointment, notify me as soon as possible so that another client can be seen. In any case, you will be charged for appointments when canceled with less than 24 hours notice.

To Know Your Fee

I am willing to discuss my fees with you and to provide a clear understanding for you of the costs of all associated services.

To Keep Me Informed

So that I may contact you whenever necessary, I will rely upon you to notify me of any changes in your name, address, and home or work phone numbers.

Your Therapist's Rights and Responsibilities

I have the responsibility to provide care appropriate to your situation, as determined by prevailing community standards. To accomplish this goal, I also have certain rights, including:

  1. The right to information needed to provide appropriate care.

  2. The right to be reimbursed, as agreed, for services provided.

  3. The right to provide services in an atmosphere free of verbal, physical, or sexual harassment.

  4. The right and ethical obligation to refuse to provide services which are not indicated.

  5. The right to change the terms of this notice at any time, with the understanding I will inform my clients of any changes.

Emergency Procedures

Should you feel that your situation requires immediate attention, I am available to return your phone calls from 9:00 am to 5:00 pm, Monday through Friday. You may leave a message on my voice messaging service and try to return calls within 24 hours. I check my messages throughout the day, but not in the evenings, on weekends or when on vacation.

If you feel that you are in a crisis at night, during the weekend, or over a holiday, or in any event that I am not immediately available, you may call your local crisis intervention center, the Holly Hill Respond line at 919.250.7000 or call 911. If you do speak with me, you may be billed at my current hourly rate for individual therapy for the time I spend with you on the phone. You should be advised that your insurance company might not reimburse you for the telephone consultation charge.

Fee Information

My fee for one 45-minute session of psychotherapy services is $115. I will inform you whenever I must raise my fees to keep up with cost of living increases.

Every client receiving services shall be responsible for the full payment of those services. I expect clients to make a payment at each session, or upon receipt of a bill. Payment for your session should be made directly to me. If at any time you find there are any problems regarding fee payment, or you need to make arrangements for a payment plan, I will be glad to speak to you regarding your concern.


Thank You

I appreciate your decision to work with me. If you have any questions at any time during the course of your therapy, please feel free to speak to me.