The initial appointment is 90 minutes for new clients. Subsequent office-based or equine-assisted sessions are 60 minutes. My rate is $120 per session. If you’re late for a session, you’ll still be charged the full session rate. In cases of financial hardship, A Path Forward, LLC does offer reduced-fee appointment times. Arrangements are made on a case-by-case basis. Please discuss your unique situation with me prior to beginning counseling. Regardless of any negotiated fee arrangements, payment for counseling services is your responsibility and due at the time of your counseling appointment.
I accept cash, personal checks, and credit cards. Please make checks payable to A Path Forward, LLC.
Cancellation/missed appointment policy
I request at least 24 hours notice of the need to cancel or reschedule an appointment. Cancellations received with less than 24 hours notice will be charged a $60 missed appointment fee. Missed appointments with no notice will be charged the full $120 appointment fee, which must be paid before the next appointment.
The use and/or possession of drugs, alcohol, firearms, and weapons of any kind are strictly prohibited at any location where therapy sessions are being conducted through A Path Forward, LLC. In addition, Chesapeake Ranch is a no-smoking facility. Due to the combustible nature of the hay and wooden buildings on site, this policy is strictly enforced. Thank you for your understanding and cooperation.
Generally speaking, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client’s consent. There are exceptions to this confidentiality, some of which are listed in section 12-43-218 of the Colorado Revised Statutes as well as other exceptions in Colorado and Federal law.
Information disclosed to a psychological professional is privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the sought testimony relates, unless ordered by a presiding court official.
Exceptions to the Rule of Confidentiality: There are exceptions to the general rule of legal confidentiality. Some of these exceptions are listed in the Colorado statues (see CRS 12-43-218 in particular). These exceptions include situations involving assessment that the client is an imminent danger to self or others, or is gravely disabled. Furthermore, treatment professionals are required by law to report suspected abuse or neglect of a child or elder. If a legal exception arises during therapy, if feasible, you will be informed accordingly.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
I will provide a copy or a summary of your health information, usually within 30 days of your request. I may charge a reasonable, cost-based fee.
Ask me to correct your medical record
You can ask me to correct health information about you that you think is incorrect or incomplete. Ask me how to do this.
I may say “no” to your request, but I’ll tell you why in writing within 60 days.
Request confidential communications
You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
I will say “yes” to all reasonable requests.
Ask me to limit what I use or share
You can ask me not to use or share certain health information for treatment, payment, or my operations. I’m not required to agree to your request, and I may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask me not to share that information for the purpose of payment or my operations with your health insurer. I will say “yes” unless a law requires me to share that information.
Get a list of those with whom I’ve shared information
You can ask for a list (accounting) of the times I’ve shared your health information for six years prior to the date you ask, who I shared it with, and why.
I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked me to make). I’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. I will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
I will make sure the person has this authority and can act for you before I take any action.
File a complaint if you feel your rights are violated
You can complain if you feel I have violated your rights by contacting me using the information in the Notice of Privacy Practices you received as part of your initial paperwork.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
I will not retaliate against you for filing a complaint.
For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, talk to me. Tell me what you want me to do, and I will follow your instructions.
In these cases, you have both the right and choice to tell me to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory
If you are not able to tell me your preference, for example if you are unconscious, I may go ahead and share your information if I believe it is in your best interest. I may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases I never share your information unless you give me written permission:
Sale of your information
Most sharing of psychotherapy notes
In the case of fundraising:
I may contact you for fundraising efforts, but you can tell us not to contact you again.
MY Uses and Disclosures
I never market or sell personal information.
How do I typically use or share your health information?
I typically use or share your health information in the following ways.
I can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run my business
I can use and share your health information to run my practice, improve your care, and contact you when necessary.
Example: I use health information about you to manage your treatment and services.
How else can I use or share your health information?
I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. I have to meet many conditions in the law before I can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
I can share health information about you for certain situations such as:
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
I can use or share your information for health research.
Comply with the law
I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.
Respond to organ and tissue donation requests
I can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
I can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
I can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
I can share health information about you in response to a court or administrative order, or in response to a subpoena.
I am required by law to maintain the privacy and security of your protected health information.
I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
I must follow the duties and privacy practices described in this notice and make a copy of it available to you.
I will not use or share your information other than as described here unless you tell me I can in writing. If you tell me I can, you may change your mind at any time. Let me know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my web site.
Please feel free to contact me if you have any questions about these privacy practices. You can call or text me at 720-441-1271 and you can email me at email@example.com.
Effective Date of this Notice: March 2, 2019
The security of my client portal
I use an online electronic patient health information system to securely store required client documentation. The system may also be used in the future for secure communication with clients, including texts and video conferencing.
The system, maintained by a company called SimplePractice, is password protected and fully compliant with the information security requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Information is hosted in a Tier 1 secure hosting provider specializing in helping healthcare organizations achieve and maintain HIPAA and Health Information Trust Alliance security requirements. The system infrastructure uses multi-factor authentication and transmits all account information with multiple layers of encryption. Web pages and APIs are secured with 128-bit Secure Socket Layer encryption. The servers or located in a facility protected by proximity readers, biometric scanners, and security guards 24 hours a day, 365 days a year.
The data stored in the system is only used for internal purposes by me, and access to your information will not be granted to other people or entities without your express written permission. By accessing the client portal, you are consenting to A Path Forward Counseling entering and maintaining your personal information in this electronic patient health information system.