Bend Psychological
Services - Office Policies
Michael G Conner, PsyD -
www.BendPsychology.com
Michael G. Conner, PsyD
Please Read Carefully
You should not consider your communication with us legally protected or confidential until you are told by us that your communication is protected or until you are told that you are a client or patient.
Please note that we use the word "provider", "us", and "we" to cover all "Services Provided". The words "we" or "us" may mean one or more professionals who may be involved in providing you services. Please let us know if you have any questions before you agree to the terms of this document.
Informed consent and HIPAA Notice
For Dr. Michael G. ConnerThis document contains information so that you can understand your rights and responsibilities. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA),
Treatment Information
Services Provided. Services provided include therapeutic assessments, psychological evaluations, assessment based interventions, crisis intervention, counseling, psychotherapy and client education. No service will be provided without your consent.
Treatment is Optional and Not Required. Counseling, psychotherapy and crisis intervention services are not required. We do not work with people who are forced to seek treatment by others. You are free to limit or end treatment at any time.
Consultation. From time to time we may find it necessary or helpful to consult with other professionals about their work with you. We believe in using a team approach when necessary. We may provide your name to people we consult with. They will be bound by the same laws and ethical standards.
Service Orientation and Approach. Our approach to working with clients and patients is primarily educational and focused on problem solving with psychotherapy and counseling to support specific problems. Therapy and counseling services are intensive and can result in significant stress as you will be asked to change your behavior. We provide information, recommendations and therapeutic environment intended to give our clients meaningful choices.
Methods. Services provided include individual, group, family, couples, marital, crisis and education. The focus of services are primarily educational and interpersonal with some interpretation directed to providing insight. Cognitive, behavioral, interpersonal and humanistic methods are used to guide services. The primary focus is on education and problem solving that leads to actions. We do not use psychoanalytic or psychodynamic approaches.
Unique Approaches. Family and individual services are provided when appropriate on weekends or after hours. Our practice is primarily educational and may be active with patients in a natural environment. For instance, it might be more effective to leave the office in order to face a fear of crowds. It may become necessary or helpful for us attend an Alcoholic's Anonymous meeting with a patient. In some cases we may take patients or groups of patients on walks, go camping, work with them in community service projects, share a meal in his office or invite patients to social events. These activities would only be offered as a means to support consultation, treatment and evaluation goals. All treatment and supportive services are optional. Patients are not required to participate in treatment.
Electronic Transmissions. Your provider may rely on e-mail to keep in touch with you. We believe private (not an employer's) e-mail system is at least as secure as regular mail or the telephone. However, it is harder to tell if an e-mail has been opened. Be cautious, in some cases an employer can monitor, keep copies and open your e-mail. Patients and clients may complete and submit their history and biographical information on-line. This submission method is at least as secure as mail. All electronic records are purged from servers and computers. Hard copies are placed in patient files. As an alternative, you may print any intake forms available on-line and complete it using a pen and mail it, it or bring it to your first appointment. You are not required to use e-mail or complete historical information on-line.
Risk of Life Changes. Therapy, counseling, crisis intervention, consultation and education services may have a profound impact. Our work is very intensive and can be stressful. We will give you the option to proceed slowly or at a more rapid pace. In most cases, there is improvement without unexpected problems. However, it is possible that there may be no change, problems or a disruptive change. For example, couples in conflict may decide to divorce. Children may become resistant to changes that you are making in your approach to parenting. Unexpected changes or results sometimes occur and cannot be predicted.
Consent of Minors. We do not offer or provide services to minors without the permission of both parents, court or the legal guardian. Minors who are 14 or older can seek treatment without parental consent. It is our policy to work with children only when the parents are involved. We will not work with minors who object to our work with their parents as well. Patients under 14 years of age who are not emancipated and their parents should be aware that the law may allow parents to examine their child’s treatment records. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, for children between 14 and 18, it is sometimes our policy to request an agreement from parents that they consent to give up their access to their child’s records. If they agree, during treatment, we will provide them only with general information about the progress of the child’s treatment, and his/her attendance at scheduled sessions. We will also provide parents with a summary of their child’s treatment when it is complete. Any other communication will require the child’s authorization, unless we feel that the child is in danger or is a danger to someone else, in which case, we will notify the parents of his concern. Before giving parents any information, we will discuss the matter with the child, if possible, and do his best to handle any objections he/she may have.
Legal Issues. We will not provide legal advice or forensic services as part of treatment. We may bring up issues for you consider, but we recommend you seek legal opinions. Without mutual agreement, and a contract for services, we generally do not provide assessments or recommendations in support of legal actions such as child custody, competency evaluations, law suites or criminal charges. Please notify your us immediately if you are involved or may become involved in a legal or criminal matter.
Contacting Your Provider. Due to our work schedule, we may
not immediately available by telephone. While we are usually in our
office between 8 AM and 5 PM, we probably will not answer the phone
when we are with a patient. When we are not unavailable, our telephone is
answered by an answering machine that we monitor frequently. We will
make every effort to return your call on the same day you make it.
If you are difficult to reach, please inform us of some times when
you will be available. If you are unable to reach us and feel that you
can’t wait for us to return your call, contact your family physician
or the nearest emergency room and ask for the for assistance
regarding a mental health emergency. If we are unavailable
for an extended time, we will provide current client with the name of a
colleague to contact, if necessary.
Confidentiality Confidentiality is a legal protection and assurance of your right to
privacy to the fullest extent allowable Federal and Oregon State
statutes. Psychotherapy, counseling, assessment and associated services
that are related to diagnosis, evaluation and treatment services
provided by licensed professionals are confidential and protected in
accordance with state law pertaining to that license. This means that
the patient has legal rights and effective steps he or she can take to
keep their records and treatment relationship private. Confidentiality
does not apply if you are not our client or patient.
Confidentiality does not apply until you are told that you are a client
or patient. HIPAA Notice Notice of Psychologists’ Policies and Practices to
Protect the Privacy of Your Health Information I. Uses and Disclosures for Treatment, Payment, and Health
Care Operations I may use or disclose your protected
health information (PHI), for treatment, payment, and health
care operations purposes with your consent. To help clarify
these terms, here are some definitions: "PHI" (Protected Health Information) refers to
individually identifiable health information. PHI includes any
identifiable health information received or created by this office or
myself. "Health information" is information in any form that
relates to any past, present, or future health of an individual. Treatment
is when we provide, coordinate or
manage your health care and other services related to your health
care. An example of treatment would be when we consult with another
health care provider, such as your family physician or another
psychologist. Payment is when we obtain reimbursement for
your healthcare. Examples of payment are when we disclose your PHI to
your health insurer to obtain reimbursement for your health care or to
determine eligibility or coverage. Health Care Operations are activities that
relate to the performance and operation of my practice. Examples of
health care operations are quality assessment and improvement
activities, business-related matters such as audits and administrative
services, and case management and care coordination. "Use" applies only to activities within
our [office, clinic, practice group, etc.] such as sharing, employing,
applying, utilizing, examining, and analyzing information that
identifies you. "Disclosure" applies to activities outside of
our [office, clinic, practice group, etc.], such as releasing, transferring,
or providing access to information about you to other parties. II. Uses and Disclosures Requiring Authorization We may use or disclose confidential information (including
but not limited to PHI) for purposes of treatment, payment, and healthcare
operations when your written informed consent is obtained. We may use
or disclose PHI for purposes outside of treatment, payment, and health
care operations when your appropriate authorization is obtained. An "authorization"
is written permission above and beyond the general consent that permits
only specific disclosures. In those instances when we am asked for
information for purposes outside of treatment, payment and health care
operations, we will obtain an authorization from you before releasing this
information. We will also need to obtain an authorization before releasing
your psychotherapy notes. "Psychotherapy notes" are notes
we have
made about our conversation during a private, group, joint, or family
counseling session, which we have kept separate from the rest of your
medical record. These notes are given a greater degree of protection than
PHI. You may revoke all such authorizations (of PHI or
psychotherapy notes) at any time, provided each revocation is in writing.
You may not revoke an authorization to the extent that (1) we have relied
on that authorization; or (2) if the authorization was obtained as a
condition of obtaining insurance coverage, and the law provides the
insurer the right to contest the claim under the policy. III. Patient's Rights and Psychologist's Duties Patient’s Rights:
Right to Request Restrictions – You have the right
to request restrictions on certain uses and disclosures of protected
health information about you. However, we are not required to agree to a
restriction you request.
Right to Receive Confidential Communications by
Alternative Means and at Alternative Locations – You have
the right to request and receive confidential communications of PHI by
alternative means and at alternative locations. (For example, you may
not want a family member to know that you are seeing me. Upon your
request, we will send your bills to another address.)
Right to Inspect and Copy – You have the right to
inspect or obtain a copy (or both) of PHI and psychotherapy notes in
our mental health and billing records used to make decisions about you
for as long as the PHI is maintained in the record. We may deny your
access to PHI under certain circumstances, but in some cases, you may
have this decision reviewed. On your request, we will discuss with you
the details of the request and denial process
Right to Amend – You have the right to request an
amendment of PHI for as long as the PHI is maintained in the record.
We
may deny your request. On your request, we will discuss with you the
details of the amendment process.
Right to an Accounting – You generally have the
right to receive an accounting of disclosures of PHI for which you
have neither provided consent nor authorization (as described in
Section III of this Notice). On your request, we will discuss with you
the details of the accounting process.
Right to a Paper Copy – You have the right to
obtain a paper copy of the notice from me upon request, even if you
have agreed to receive the notice electronically. Psychologist’s Duties: We are required by law to maintain the privacy of PHI and
to provide you with a notice of our legal duties and privacy practices
with respect to PHI. we reserve the right to change the privacy policies
and practices described in this notice. Unless we notify you of such
changes, however, we are required to abide by the terms currently in
effect. If we revise our policies and procedures, we will post these in
our office and mail you a copy if reasonably possible when information is
requested from your file. IV. Questions and Complaints If you have questions about this notice, disagree with a
decision we make about access to your records, or have other concerns about
your privacy rights, you may contact Michael Conner, Psychologist at
388-5660. If you believe that your privacy rights have been violated and
wish to file a complaint with me/my office, you may send your
written complaint to Michael Conner, Psy.D at 965 NE Wiest Way, No. 2, Bend
Oregon, 97701. You may also send a written complaint to the Secretary of
the U.S. Department of Health and Human Services. The person listed above
can provide you with the appropriate address upon request. You have
specific rights under the Privacy Rule. We will not retaliate against you
for exercising your right to file a complaint. V. Effective Date, Restrictions and Changes to Privacy
Policy This notice will go into effect on April 14, 2003.
We reserve the right to change the terms of this notice and to make the new
notice provisions effective for all PHI that we maintain. We will provide
you with a revised notice when information is requested. Limits of Confidentiality The office for Bend Psychological Services is a separate building
attached to Dr. Conner's home. There is a separate outside entrance. Dr.
Conner's wife, daughter, neighbors and occasional house guests may see
you enter through the office front door. The reason for your visit,
appointment and name will not be revealed to anyone without your
permission. Dr. Conner's wife is an employee and is bound by the same
laws regarding confidentiality. People come to the office for a variety
of reasons that are not related to treatment or mental health services.
The reasons patients or clients visit our office are not revealed to
anyone without your permission. Bend Oregon is a small town. It is
possible that someone in the area may recognize you. You should be aware that we practice with other
mental health professionals in some cases and that we employ
administrative staff. You will notified in that is the case. In most
cases, we need to share your protected information with these individuals for both clinical and administrative purposes, such as
scheduling, billing and quality assurance. All of the mental health
professionals are bound by the same rules of confidentiality. All
staff members have been given training about protecting your privacy
and have agreed not to release any information outside of the
practice without the permission of a professional staff member. There are some situations where we are permitted or required to disclose
information without either your consent or
authorization: If you are involved in a court proceeding and a
request is made for information concerning your diagnosis and
treatment, such information is protected by the psychologist-patient
privilege law. we cannot provide any information without your (or
your personal or legal representative’s) written authorization, or a
court order. If you are involved in or contemplating litigation, you
should consult with your attorney to determine whether a court would
be likely to order us to disclose information. If a government agency is requesting the information for health oversight activities,
we may be required to
provide it for them. If a patient files a complaint or lawsuit against
me, we may disclose relevant information regarding that patient in
order to defend myself. If a patient files a worker’s compensation claim,
he/she automatically authorizes us to release any information
relevant to that claim. Disclosures required by health insurers or to
collect overdue fees are discussed elsewhere in this Agreement. There are some situations in which
we are legally obligated to take actions, which we believe are necessary to attempt to
protect others from harm and we may have to reveal some information about
a patient’s treatment. These situations are unusual in our practice. If there is a child abuse investigation, the law
requires that we turn over our patient’s relevant records to the
appropriate governmental agency, usually the local office of the
Department of Human Services. Once such a report is filed, we may be required to provide additional
information. If there is an elder abuse or domestic violence
investigation, the law requires that we turn over our patient’s
relevant records to the appropriate governmental agency, usually the
local office of the Department of Human Services. Once such a report
is filed, we may be required to provide additional information. If we believe that a patient presents a clear and
substantial risk of imminent, serious harm to another person, we may
be required to take protective actions. These actions may include
notifying the potential victim, contacting the police, or seeking
hospitalization for the patient. If we believe that a patient presents a clear and
substantial risk of imminent, serious harm to him/her self, we may be obligated to seek hospitalization for him/her, or to contact family
members or others who can help provide protection. If such a situation arises, we will make a reasonable effort
to fully discuss it with you before taking any action and we will limit
our disclosure to what is necessary. 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 now or in the future. The laws governing confidentiality
can be quite complex and we are not an attorney. In situations where
specific advice is required, formal legal advice may be needed.