Consent & HIPAA Acknowledgement

Please read this document carefully. It provides important information about Judyann McCarthy’s professional services, business policies, confidentiality, HIPAA privacy practices, patient rights, professional fees, billing, contact procedures, records, and treatment expectations.

Psychological services may include clinical assessments, psychotherapy, consultation, education, and crisis intervention. Psychotherapy varies depending on presenting concerns and individual circumstances. Therapy can involve benefits and risks, including uncomfortable feelings when difficult subjects are discussed, as well as improved relationships, solutions to specific problems, and reduction in distress. There are no guarantees of outcome.

Confidentiality

Information shared in therapy is kept confidential and is not disclosed without written permission, with limited exceptions required or permitted by law. These may include supervision or consultation, suspected abuse or neglect of a child, elderly person, or disabled person, imminent harm to self or others, court-related proceedings, or a complaint or lawsuit involving the therapist.

Sessions, Fees, Billing, Insurance, Contact, and Records

Sessions are 50 minutes. The fee is $150 for individual sessions and $200 for couples sessions. Cancellations require 24-hour notice. Payment is expected at the time of session. Judyann does not participate on insurance panels and is considered an out-of-network provider. Receipts may be provided for clients who wish to submit to insurance. Professional records are maintained as required by law and HIPAA. Clients have rights regarding access, amendment, restrictions, accounting of disclosures, and copies of privacy notices.

HIPAA Notice of Privacy Practices

This notice describes how protected health information may be used and disclosed for treatment, payment, health care operations, safety, and other purposes permitted or required by law. Clients have rights to request limits, request confidential communication, see and receive copies of protected health information, request corrections, receive a list of certain disclosures, and receive copies of the privacy notice.