Covered Bridge Family Resources, LLC
“Success is found in your strengths”
Notice of Privacy Practices, Policy Guidelines & Client Rights For Services
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Welcome to Covered Bridge Family Resources, LLC. We are looking forward to meeting with you and to determining how we can be of assistance to you. Please take the time to read the following information and ask any questions you may have regarding this information. You will need to sign a form indicating receipt of this information and giving consent for treatment.
How Your Health Information May be Used or Disclosed
Covered Bridge Family Resources, LLC uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Covered Bridge Family Resources, LLC and/or its’ contracted therapists or employees.
Information submitted in writing may be hand delivered to your therapist or mailed to Covered Bridge Family Resources, LLC PO Box 134 Zumbrota MN 55992.
For Treatment.Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, psychologist, clinical social worker, counselor or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions. The following agency staff may use medical records: clinical staff, supervisors, receptionists, administrative assistance, transcriptionist, billing staff, and medical records personnel.
For Payment.Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use and disclose your mental health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payer, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment. If you are eligible to receive county or grant based funding, some information about you will be provided to those staff. The Minnesota Department of Human Services also has the right to review your medical record.
For Health Care Operations. Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use and disclose mental health information about you for operational purposes.For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
Appointments.Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use your information to provide appointment reminders, information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
How Contacts are Made: Information is exchanged with you or others designated individual/agencies in the following ways: telephone, cell phone, mail, fax, and email. Messages will be left on voicemail attached to the phone number provided. If you do not wish to have any of these forms of communication used, you must provide us with a written notice. If you would like confidential communication in an alternative way or at an alternative location, such as communication only at a specific phone number, or by mail only, you must provide us with that information in writing.
Treatment Information: Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use your information to contact you about treatment alternatives, health related benefits and services that may be of interest to you.
Required by Law.Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use and disclose information about you as required by law. For example, Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may disclose information for the following purposes:
Public Health.Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities, including disaster relief efforts.
Safety:Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use your information to inform necessary individuals or agencies to lessen a serious or imminent threat to the health or safety of another person or the public, including information regarding admitted participation in a violent crime or escape from lawful custody. In addition, we may do the same if we believe there to be serious or imminent threat to your own safety by means of self-harm.
Decedents.Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Research. Covered Bridge Family Resources, LLC and/or its’ contracted therapists and/or staff may use your health information for research purposes after an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research. We occasionally develop statistics and other anonymous information about the clients we serve that will not identify you in any way.
Health and Safety.Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions.Specialized government functions such as protection of public officials or reporting to various branches of the armed services may require use or disclosure of you health information.
Workers Compensation.Your health information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation.
Your Health Information Rights
You have the right to:
You may complain to Covered Bridge Family Resources, LLC and to the Department of Health and Human Services, if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.If you are dissatisfied with our services, tell your therapist. If you remain dissatisfied or still have questions, you may follow the Grievance Procedure outlined below.
Treatment of Minors
There are specific laws that address confidentiality for minors (those under 18). By law, custodial parents/legal guardians have the right to access mental health records except when the minor is married, legally emancipated, or has borne a child. Other exceptions include when the information pertains to venereal disease, chemical dependency or pregnancy and related conditions. In addition, a minor may request, in writing, including the reason, that their mental health record be withheld from their parent or legal guardian.In addition, a therapist can withhold records if, in their professional judgment, they determine that disclosing the information would be detrimental to the physical or mental health of the minor or that the minor is likely to cause harm to themselves or another.
It is our goal to both maintain the privacy of our minor clients as well as keep parents/guardians informed of important information and progress. We ask that you assist us in this by talking openly with us regarding any questions or concerns you have and allowing your child the space and privacy to develop a trusting relationship with their therapist so they can have an opportunity for growth in therapy.
In couple and family therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. Your therapist will use clinical judgment when revealing such information.Your therapist will not release records to any outside party unless so authorized to do so by all adult family members who were part of the treatment.
Not all dual relationships are unethical or avoidable. Therapy never involves sexual or any other dual relationship that impairs a therapist’s objectivity, clinical judgment, or therapeutic effectiveness or can be exploitative in nature. Therapists will assess carefully before entering into nonsexual and nonexploitative dual relationships with clients. Zumbrota and the surrounding area is a small community and many clients know each other and the therapists and employees/independent contractors of Covered Bridge Family Resources, LLC from the community. Consequently, you may bump into someone you know in the waiting room or into individuals from Covered Bridge Family Resources, LLC out in the community. Individuals from this agency will never acknowledge working therapeutically with anyone without his/her written permission. Many clients choose their therapist because they know him/her before they enter into therapy with him/her and/or are aware of his/her stance on a topic.Nevertheless, your therapist will discuss with you, the often-existing complexities, potential benefits, and difficulties that may be involved in such relationships. Dual or multiple relationships can enhance therapeutic effectiveness but can also detract from it and often it is impossible to know that ahead of time. It is your, the client’s, responsibility to communicate to your therapist if the dual relationship becomes uncomfortable for you in any way. Your therapist will always listen carefully and respond accordingly to your feedback. Your therapist will discontinue the dual relationship if s/he finds it interfering with the effectiveness of the therapeutic process or the welfare of the client and, of course, you can do the same at any time.
Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters that may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to, divorce and custody disputes, injuries, lawsuits, etc.), neither you (client or minor client’s parent/guardian) nor your attorney, nor anyone else acting on your behalf will call on anyone, including your therapist, from this agency to testify in court or at any other proceeding, nor will a disclosure of your records be requested. This is requested in order to best maintain the therapeutic relationship for the client and therapist and prevent or limit possible harm that can come from exposure of personal information to those outside of the therapeutic relationship.There may incidents when information must be released due to mandatory legal obligations beyond the scope of this agreement.
Health Insurance and Confidentiality of Records
Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. Only the minimum necessary information will be communicated to the carrier. Covered Bridge Family Therapy Resource, LLC or our contracted billing agent, have no control or knowledge over what insurance companies do with the information submitted or who has access to this information once submitted. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future eligibility to obtain health or life insurance. The risk stems from the fact that mental health information is entered into insurance companies’ computers and becomes a part of your medical record there.
Confidentiality of e-mail, cell phone, and fax communication
You should be aware that e-mail and cell phone (also cordless phones) communication can be accessed by unauthorized people and, hence, the privacy and confidentiality of such communication can be compromised. Faxes can be sent erroneously to the wrong address. Please notify your therapist at the beginning of treatment if you decide to limit in any way the use of any or all of the above-mentioned communication devices. However, it is important to note that such limits may delay the ability of your therapist to respond to you or your requests to exchange information. Please use only phone contact in emergency situations when you are attempting to contact us, do not use e-mail or faxes.
Obligations of Covered Bridge Family Resources, LLC
Limits to confidentiality include:
Covered Bridge Family Resources, LLC reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains.Revised notices will be made available to you. The practices became effective April 15, 2003.
As a client of Covered Bridge Family Resources, LLC, you have responsibilities as well as, rights.
The Staff at Covered Bridge Family Resources, LLC are committed to respecting your rights. The staff also has rights.
Voice mail is available 24 hours a day, 7 days a week. Messages are checked on regular business days Monday - Thursday. If your message is urgent, please indicate that and leave a number where you can be reached. If this is an emergency and you cannot wait for a returned call, please call the SE Minnesota Crisis Response Team (844) 274-7472, an Emergency room near you or, 911 or consult your individual crisis plan created during therapy, if you have one. Appointments are made on an individual basis.
The length and frequency of therapy appointments will be determined according to your needs.
A 24-hour notice is requested if you need to cancel.
Andrea Smothers received a Bachelor of Social Work degree from Winona State University in Minnesota and a Masters of Social Work degree from Washington University in St. Louis MO.Her concentration was in children and youth, with a specialization in family therapy. Andrea is a Licensed Independent Clinical Social Worker, state of Minnesota, and a member of the National Association of Social Workers.
Diana Beran received her Bachelor's degree in Science and her Masters of Science/Education degree from The University of Wisconsin-River Falls in River Falls, Wisconsin. She is a Licensed Psychologist in the state of Minnesota working with behavior change and coping skills, assistance with balancing work, home life and managing stress, providing tools & hope for managing anxiety, depression, loss, grief & unwanted changes, addressing issues of identity, meaning & purpose and resolving relationship conflicts.
BILL OF RIGHTS OF CLIENTS
Consumers of psychological services offered by psychologists licensed by the State of Minnesota have the right:
Counseling/ therapy is a process by which individuals who are dissatisfied with some aspects of their lives enter into a relationship with a trained professional to gain greater insight into their situation and to develop more effective ways of responding to life experiences. Counselors/Therapists do not make decisions for their clients; rather, they ask questions, offer information, provide activities, and make comments to help individuals and families understand each other better, make one’s own choices, and become more self-reliant. Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. Your counselor/therapist will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in your experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, and so forth, or experiencing anxiety, depression, insomnia, and so forth. Your counselor/therapist may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations that can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, your counselor/therapist is likely to draw on various psychological approaches according, in part, to the problem that is being treated and his/her assessment of what will best benefit you. These approaches can include behavioral, cognitive-behavioral, psychodynamic, system/family, solution focused, play techniques, interpersonal, support and/or psychoeducational.