Aimee Vandemark, LCSW
109- B Millstone Drive, Hillsborough, NC 27278
Phone: 919-370-0132
POLICIES AND PROCEDURES
Updated April 2017
Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us.
PSYCHOTHERAPY SERVICES
Psychotherapy is not easily described in general statements. It varies depending on the personalities of the therapist and client, and the particular problems you bring forward. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.Psychotherapy can have benefits and risks. Since 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 benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.
PSYCHOTHERPAY SESSIONS
I normally conduct an evaluation that will last from 1 to 3 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. I will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week at a time we agree on, although some sessions may be longer or more frequent. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation. Your health plan does not cover payment for missed appointments; therefore, you will be responsible for payment in full. Every effort will be made to begin and end sessions on time. If I am late beginning a session, then when possible, the session will be extended to allow for the full session time. If you happen to be late for a session, then the session will end on time.
PROFESSIONAL FEES and INSURANCE:
My fees are as follows:
Individual Therapy Session lasting 45-50 minutes: $100.00
Individual Therapy Session lasting 75-90 minutes: $120.00
Family Therapy Session lasting 45-50 minutes: $ 120.00
Missed Appointment or Cancelations without 24 hour notification: $100.00 **
While most of the services I offer typically are covered by health insurance policies, some may not be. Kindly make sure you review your policy carefully for coverage information.
Services Not Covered by Insurance
- Missed appointments
- Telephone sessions (calls longer than 10 minutes are prorated at the therapy session rate)
- Written communication I provide on a patient’s behalf (preparation time prorated at the therapy session rate)
** In addition to fees, therapist reserves the right to discontinue services if there are frequent cancellations and/or two or more missed appointments without notice as these disrupt the therapeutic work and can negatively impact the therapeutic relationship.
BILLING AND PAYMENTS
You will be expected to pay for each session at the time it is held, unless we agree otherwise.
I reserve the right to add a monthly service fee of 12%APR or 1% a month to all accounts over 60 days past due. Please have your check or money ready at the beginning of the session so that we can use the full session to focus on your needs.
If we are billing your insurance company,a diagnosis code is required. I will file each session with the insurance company on your behalf and can provide a monthly statement to you.
CONTACTING ME
I check my voicemail throughout the day and generally return calls between 10am and 7pm Monday through Friday. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you can't wait for me to return your call, contact your family physician or the nearest emergency room and ask for the clinician/psychologist/psychiatrist on call. If I will not be available for an extended time, I will provide you with the name of a colleague to contact, if necessary.
PROFESSIONAL RECORDS
The laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of your records, or I can prepare a summary for you instead. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. If youwish to see your records, I recommend that you review them in my presence so that we can discuss the contents.
MINORS
If you are under eighteen years of age, please be aware that the law generally provides your parents the right to examine your treatment records. It is my policy to ask parents to not access your records. If they agree, I will provide them only with general information about our work together. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss. At the end of your treatment, I will prepare a summary of our work together for your parents, and we will discuss it before I send it to them.
LICENSURE
I am a Licensed Clinical Social Worker and licensed to practice in the state of North Carolina. In order to provide competent mental health services, I sometimes consult with other licensedprofessionals about cases. These consultations are designed to ensure that you receive high-quality, ethical treatment. Any consultations that I make on your behalf will be made in such a way that your confidentiality is protected.
CONFIDENTIALITY
In general, all information between provider and patient is held strictly confidential, and I can only release information about our work to others with your written permission. But there are a few exceptions.
1. If I believe the client is a threat to him or herself, I may be obligated to seek hospitalization for him or her or to contact family members or others who can help provide protection.
2. If I believe that a client is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.
3. If I believe that a child, elderly person, or disabled person is being abused or neglected, I am required to file a report with the appropriate state agency.
It is rare that I have to disclose your information. However, if I have to do so, it is my policy to, whenever possible, discuss any action that is being considered. Legally, I am not obligated to seek your permission, especially if such a discussion would prevent me from securing your safety or the safety of others.
I meet regularly with a clinical supervisor for consultation, and I occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep the information confidential. If you don't object, I will not tell you about these consultations unless I feel that it is important to our work together.
While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.
FEEDBACK
I am interested in any positive or negative feedback you may have regarding the services you receive. You will have the opportunity to provide feedback at the end of your counseling, but I welcome and encourage you to provide feedback at any time during the therapy process. If for any reason you are not satisfied with the counseling process and after discussion it is not resolved to your satisfaction, I will provide you with a referral to another competent therapist.
NOTICE OF PRIVACY PRACTICES For the Practice of Aimee Vandemark, LCSW
Aimee Vandemark, MSW, LCSW has a legal duty to protect private information about you. I am required to protect the privacy of health information about you or your child. I am required to follow the procedures in this Notice. I reserve the right to change the terms of this Notice and to make new notice provisions by first:
• Posting the revised notice in my office;
• Making copies of the revised notice available upon request;
• Giving a notice of revision to all clients.
I MAY USE AND DISCLOSE INFORMATION UNDER THE FOLLOWING CONDITIONS.
1. I may use and disclose information about you to provide services.This may include communicating with other health care providers regarding your treatment. For example, I may use and disclose information when you need a referral for other health care services, or to receiveauthorization to begin services.
2. I may use and disclose information about you to obtain payment for services. Generally, I may use and give your medical information to others to bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, I may share information about these services with your insurer to assure that services are covered.
3. I may use and disclose your information for health care operations.I may use and disclose information about you in performing business activities, which I call “health care operations”. These “health care operations” allow us to improve the quality of care I provide and reduce health care costs. Examples of the way I may use or disclose information about you for “health care operations” include the following:
• Reviewing and improving the quality, efficiency and cost of care that I provide to you and my other clients.
• Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
• Cooperating with outside organizations that assess the quality of the care I provide. These organizations might include the NC Division of Mental Health/Developmental Disabilities/Substance Abuse Services; Area Mental Health Authorities; or the NC Council of Community Programs, or consultation that I might receive to improve my practice.
4. I may disclose information to persons involved in your care.I may disclose information about you to a relative, or any other person you identify if that person is involved in your care and if the information is relevant to your care. Where the client is a minor, for instance, I may disclose information about the minor to a parent, guardian, or other person responsible for the minor except in limited circumstances. I may also disclose information about you to a relative or other person involved in your care if there is an emergency situation, and I need to notify someone of your location or condition.You may request that I not disclose information to persons involved in your care. I will generally comply with your request, unless there is an emergency, or if the client is a minor. If the client is a minor, I may or may not be able to comply with your request.
5. Other circumstances in which Aimee Vandemark, LCSW may use and disclose information about you. I may use and/or disclose information about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
• When the use and/or disclosure is required by law. For example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding, or when the disclosure relates to victims of abuse, neglect or domestic violence.
• When the use and/or disclosure is for health oversight activities. For example, I may discloseinformation about you to a state or federal health oversight agency which is authorized by law tooversee our operations or to assure the public health.
• When the disclosure is for law enforcement purposes. For example, I may disclose informationabout you in order to comply with laws that require the reporting of certain types of wounds orother physical injuries, or in reporting of missing persons. • When the use and/or disclosure is to avert a serious threat to health or safety. For example, I maydisclose information about you to prevent or lessen a serious and imminent threat to the health orsafety of a person or the public.
• When the use and/or disclosure relates to correctional institutions and in other law enforcementcustodial situations. For example, in certain circumstances, I may disclose information about you to a correctional institution having lawful custody of you.
6. I may use or disclose information about you with your authorization.Under any circumstances other than those listed above, I will ask for your written authorization before I use or disclose information about you. If you sign a written authorization allowing me to disclose information about you in a specific situation, you can later cancel your authorization in writing. If you cancel your authorization in writing, I will not disclose information about you after I receive your cancellation, except for disclosures which were being processed before I received your cancellation.
YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU.
1. You have the right to request restrictions on uses and disclosures of information about you. I am not required to agree to your requested restrictions. However, even if I agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Department of Health and Human Services, and uses and disclosures described in the previous section of this Notice.
2. You have the right to request different ways to communicate with you. You have the right to request how and where we contact you. For example, you may request that I contact you at your work address or phone number or by email.
3. You have the right to request to see and receive a copy of information created by Aimee Vandemark, LCSW in your clinical file.
4. You have the right to request amendments or changes to clinical, billing and other records used to make decisions about you. If you believe that I have information that is either inaccurate or incomplete, I may add information to indicate the problem and notify others who have copies of the inaccurate or incomplete information.
5. You have the right to receive a written list of disclosures about you. You may ask for disclosures made up to six (6) years before your request. I am not required to include disclosures:
For your treatment; For billing and collection of payment for your treatment; For our health care operations; Authorized by you, or which are made to individuals involved in your care; Allowed or required by law when the use and/or disclosure relates to certain specialized government functions; As part of a limited set of information which does not contain certain information which would identify you. I will include the date of the disclosure, the name (and address, if available) of the person or the list organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure. You may request a listing of disclosures by notifying Aimee Vandemark, LCSW
6. You have the right to request a paper copy of this Notice at any time by notifying Aimee Vandemark, LCSW.
7. You have the right to request restrictions on uses and disclosures. You have the right to request that we limit the use and disclosure of information about you for treatment, payment and health care purposes.
YOU MAY FILE A COMPLAINT ABOUT MY PRIVACY PRACTICES.
If you think your privacy rights have been violated by me you can contact the Social Work Licensure Board. If you file a complaint, I will not take any action against you or change our treatment of you in any way.
When you have had these rights explained and received a copy, please sign the attached form.