Confidentiality

Confidentiality is an essential part of any clinical relationship. All aspects of your participation in clinical services at Peace For The Heart Counseling, including the scheduling of appointments, content of counseling sessions, and any records that we keep, are confidential as outlined by federal and state law. Please read our Consent Form and Notice of Privacy Practices which both provide more detail about how we handle your confidential information. Communication between a clinician and a client may only be disclosed when: (a) the client signs a Consent Form and/or our release of information form authorizing such disclosure, (b) in cases of immediate danger of serious harm to the client or someone else, or (c) other infrequent circumstances as described below under “Limits of Confidentiality.” Counseling records are maintained in files completely separate from this website and can not be accessed by any non-Peace For The Heart Counseling staff without the client’s signed authorization. Clients are encouraged to address any questions or concerns about this important issue with their clinician.

Peace For The Heart Counseling, PLLC operates within professional ethical guidelines and applicable federal and state laws which protect the privacy of your mental health records. (For more information, see our Notice of Privacy Practices)

Notice of Privacy Practices

Limits of Confidentiality

About your Counseling Record

Consent

Client Rights and Responsibilities

Consent for Minors

In most cases, your written and signed authorization is required before information concerning your care can be disclosed to individuals outside of Peace For The Heart Counseling, PLLC, including parents, friends, partners, and legal spouse. Below are some of the cases in which the law dictates that your signed authorization may not be required in order for Peace For The Heart Counseling, PLLC to release information:

• If a Peace For The Heart Counseling, PLLC employee believes that you are likely to harm yourself and/or another person, he or she may take action necessary to protect you or others by contacting law enforcement officers or a physician.

• If a Peace For The Heart Counseling, PLLC clinician has cause to believe that a child has been or may be abused or neglected, the clinician is required to make a report to the appropriate state agency.

• If a Peace For The Heart Counseling, PLLC clinician has cause to believe that an elderly or disabled person has been or may be abused, neglected, or subject to financial exploitation, the clinician is required to make a report to the appropriate state agency.

• Information disclosed about a person from whom you sought counseling in the State of Texas behaving toward you in a sexually inappropriate manner must be reported (your identity may remain anonymous at your request).

• If your records are requested by a valid subpoena or court order, we must respond.

• If you are a minor (under the age of 18).

About Your Counseling Record

Your counseling record contains documentation relevant to your care at the Peace For The Heart Counseling, PLLC. It will be retained for at least seven (7) years after your last contact for services.

Before receiving services, you must read and sign the attached Consent Form during client intake.

Your Rights

• To Appropriate Treatment

A clinician may meet with you for one or two sessions to determine the kind of services that will best meet your needs, and whether we can provide those services here at Peace For The Heart Counseling, PLLC. If your needs cannot be met within this agency, you will be given referrals for qualified clinicians or other resources.

• To Physical and Emotional Safety

Your clinician will do everything possible to protect your physical and emotional welfare. This includes intervening on your behalf if your well-being becomes threatened by emotional or physical stress.

• To Provide Feedback to Us

You will be asked periodically to provide a more formal evaluation of the services you receive at Peace For The Heart Counseling, PLLC. If you wish to comment on the services you have received, you may do so at any time. Comment forms are available at our website and in the waiting areas. You may leave your completed comments in one of the in the waiting area or with an employee. Your comments and your formal evaluations are essential to our continuing effort to improve the quality of our services.

Ethical or professional conduct may be reported to:

Texas Behavioral Health Executive Council

333 Guadalupe St, Tower 3, Room 900
Austin, Texas 78701
tel (512) 305-7700
Investigations/Complaints 24-hour, toll-free system (800) 821-3205

The Texas Behavioral Health Executive Council investigates and prosecutes professional misconduct committed by marriage and family therapists, professional counselors, psychologists, psychological associates, social workers, and licensed specialists in school psychology. Although not every complaint against or dispute with a licensee involves professional misconduct, the Executive Council will provide you with information about how to file a complaint. Please call 1-800-821-3205 for more information.

Texas State Board of Examiners of Professional Counselor Complaints

Your Responsibilities

• Completion of Paperwork

All clients who come to Peace For The Heart Counseling, PLLC are asked to complete paperwork prior to seeing a clinician for an initial consultation.

• Regular Attendance

You are expected to attend and be on time for all scheduled appointments. If you are unable to attend a session, it is your responsibility to cancel no later than 24 hours PRIOR to your appointment. You will be charged for the full session at current rates when you miss your appointment without canceling by that time, regardless if using Healthcare Insurance. Please note that the charge will appear as a charge “Peace of the Heart No Show / Late Cancellation charge.”

• Active Participation

To benefit from the services you receive, you should be prepared for your sessions, actively participate with your clinician, and carry out plans made with your clinician.

• Evaluation of Services

We ask that you complete the evaluation forms provided to you, so that we can assess the quality of our service delivery.

Consent

regardless if using Healthcare InsuranceI consent to receive treatment from Peace For The Heart Counseling, PLLC clinician(s).

1.  I have read and understand that Texas State Law permits or requires the disclosure of confidential information without my consent under very specific circumstances (see Notice of Privacy Practices).

2.  I am giving my consent to Peace For The Heart Counseling, PLLC to use my health information from my record for purposes of providing me treatment and for coordination of my care as defined and explained in more detail in the company Notice of Privacy Practices (“Notice”). Peace of The Heart Counseling’s Notice provides more complete information about how protected health information may be used, and a copy of this Notice is available at http://peacefortheheart.com/confidentiality.html or at the office front desk upon request. I understand that Peace For The Heart Counseling, PLLC reserves the right to modify its Notice, and a revised Notice will be provided upon request.

3.  I authorize the sharing of information among Peace For The Heart Counseling, PLLC clinicians who are involved in my mental health treatment.

4.  I have the right to ask Peace For The Heart Counseling, PLLC to restrict how my protected health information is used to carry out treatment or health care operations. I understand that Peace For The Heart Counseling, PLLC is not required to agree to my request for restrictions, but if it does, I understand that Peace For The Heart Counseling, PLLC is bound by its agreement.

5.  I may revoke this Consent Form at any time by notifying Peace For The Heart Counseling, PLLC in writing of my intention to revoke it. My revocation letter will not affect any use of my health information by Peace For The Heart Counseling, PLLC for treatment or health care operations before the revocation is received. The revocation letter shall be addressed to: Peace For The Heart Counseling, PLLC ATTN: Records Office 1100 NW Loop 410 Suite 700,  Castle Hills, Texas 78213

6.  I will be charged a full session fee at current rates if I miss a scheduled Peace For The Heart Counseling, PLLC appointment without canceling at least 24 hours in advance of the appointment regardless if using Healthcare Insurance. I understand that these charges will appear on my statement.

I hereby grant my permission for any counseling, testing, or diagnostic evaluation that may be deemed necessary by my clinicians. I understand that treatment is a joint effort between my clinicians and myself, the results of which cannot be guaranteed. Progress depends on many factors including motivation, effort, and other life circumstances. I agree that I will be responsible for the payment of all fees. I know that I can end treatment at any time and that I can refuse any requests or recommendations made by my clinicians.

Consent for Minors

If you are under the age of 18, Texas State Law requires that we obtain permission from your parent or managing conservator/guardian in order to offer you counseling services.

Consent for Treatment of a Minor