AI Policy: Ensuring Confidential, Human-Centric Care

AI Policy: Ensuring Confidential, Human-Centric Care

Wellness Lab & Clinics takes a careful, conservative approach to artificial intelligence (AI) in our practice. This policy explains what AI is and is not used for in your care, what your information is and is not exposed to, and what you can expect.

Commitment to Human Clinician Care and AI Use Standards

The therapeutic relationship is between you and your human clinician. AI does not replace clinical judgment, attend your sessions, or make treatment decisions about your care. Where AI tools are used in the operation of our clinic, we evaluate them against three standards: does it protect client confidentiality, is it appropriate for healthcare use, and does it serve the client's interest?

Where AI Is Not Used

To be explicit about what does not happen with your information:

• Your sessions are not recorded or transcribed by AI

• Your clinical notes are not processed through public AI tools like ChatGPT, Claude, or Gemini

• Your personal health information is not used to train any AI model

• AI does not make clinical decisions, assessments, or diagnoses about you

• Your therapist does not consult AI as a substitute for clinical supervision or peer consultation

Third-Party Vendors

Some of the tools we use to operate our clinic have their own AI features built in. Where this is the case, we evaluate the vendor's data handling and choose configurations that protect client confidentiality:

• SimplePractice (EMR): Our electronic health record is HIPAA-compliant. Any AI features within SimplePractice operate under SimplePractice's own privacy policy, which is available at simplepractice.com/privacy.

• Email and scheduling tools: We use standard business communication tools, such as Gmail. These may use AI features such as spam filtering or suggested replies. Sensitive clinical content is not transmitted through general email channels.

What This Means for You

You can expect that:

• The therapist sitting with you (in person or virtually) is the person responsible for your care

• The notes in your clinical file are written by your therapist, not generated by AI

• Your information is not being used to improve any AI system

• If anything about how AI is used in our practice changes in a way that touches your care, we will tell you and obtain your consent first

Questions

If you have questions about AI use, your data, or how any specific tool is used in our practice, please reach out: cathi@WellnessLabAndClinics.com 541.499.5661

Note: This AI Policy is a companion to our clinic’s Privacy Policy. Read both for a complete picture of how your information is handled at Wellness Lab & Clinics.

Right to Revoke Consent

Your consent is voluntary. You have the right to withdraw this consent at any time by notifying us [me] in writing. Revoking your consent will not affect your ability to receive therapy services.

CONSENT FOR TELEHEALTH CONSULTATION

CONSENT FOR TELEHEALTH CONSULTATION

In response to the rising need for healthy alternatives to in-person appointments we offer virtual sessions using a HIPAA compliant, secure system called SimplePractice Telehealth, which is a video conferencing technology. Please note that some insurance carriers may not consider this the same as a direct patient/health care provider visit due to the fact that we will not be in the same room together.

There are potential risks to this technology, including interruptions, unauthorized access and technical difficulties.

1. I understand that my health care provider wishes me to engage in a telehealth consultation.

2. My health care provider explained to me how the video conferencing technology that will be used to affect such a consultation will not be the same as a direct client/health care provider visit due to the fact that I will not be in the same room as my provider.

3. I understand that a telehealth consultation has potential benefits including easier access to care and the convenience of meeting from a location of my choosing.

4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

5. I understand that telehealth appointments in a moving vehicle are not recommended due to safety issues. If I am not able to pull over, for my safety the appointment will end and I will be charged for the full session.

6. I have had a direct conversation with my provider, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.

CONSENT TO USE THE TELEHEALTH BY SIMPLEPRACTICE SERVICE

Telehealth by SimplePractice is the technology service we will use to conduct telehealth videoconferencing appointments. It is simple to use and there are no passwords required to log in. By signing this document, I acknowledge:

1. Telehealth by SimplePractice is NOT an Emergency Service and in the event of an emergency, I will use a phone to call 911.

2. Though my provider and I may be in direct, virtual contact through the Telehealth Service, neither SimplePractice nor the Telehealth Service provides any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.

3. The Telehealth by SimplePractice Service facilitates videoconferencing and is not responsible for the delivery of any healthcare, medical advice or care.

4. I do not assume that my provider has access to any or all of the technical information in the Telehealth by SimplePractice Service – or that such information is current, accurate or up-to-date. I will not rely on my health care provider to have any of this information in the Telehealth by SimplePractice Service.

5. To maintain confidentiality, I will not share my telehealth appointment link with anyone unauthorized to attend the appointment.

By signing this form, I certify:

• That I have read or had this form read and/or had this form explained to me.

• That I fully understand its contents including the risks and benefits of the procedure(s).

• That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• I am also required by law to provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2.

• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in the diagnosis and treatment of your mental health condition.

If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Furthermore, information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. However, for records protected by 42 C.F.R. Part 2, such records or testimony relaying their content shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order is issued in accordance with 42 C.F.R. Part 2.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

   • For my use in treating you.

   • For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

   • For my use in defending myself in legal proceedings instituted by you.

   • For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

   • Required by law, and the use or disclosure is limited to the requirements of such law.

   • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

   • Required by a coroner who is performing duties authorized by law.

   • Required to help avert a serious threat to the health and safety of others.

2. Substance Use Disorder (SUD) Counseling Notes. I may also maintain “SUD counseling notes,” which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time, except to the extent that I have already acted upon it to disclose these notes in accordance with your initial authorization.

3. Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

4. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.

10. Appointment reminders and health-related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

2. Fundraising. If I intend to use or disclose your records protected by 42 C.F.R. Part 2 for fundraising for my benefit, I will provide you with a clear and conspicuous opportunity to opt-out before any such use or disclosure occurs.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone), or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes” and “SUD counseling notes” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request. You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By signing below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.

Informed Consent for Psychotherapy

Informed Consent for Psychotherapy

General Information The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding of how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

The Therapeutic Process You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you as well as to help you clarify what it is that you want for yourself.

Consent is a valuable part of our work. If you do not understand or are uncomfortable with the questions or content brought up in the therapeutic process, please use your right to let me know any time (before, during, or after) our work together. We will talk through the ways you can express this request verbally and non-verbally throughout therapy.

Confidentiality The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons through a signed Release of Information. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts themself in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if the information is obtained for the purpose of rendering an expert’s report to an attorney.

-Occasionally I may need to confidentially consult with other professionals in their areas of expertise in order to provide the best treatment for you. This includes clinical supervision and consultation as a process for certification with the American Association of Sexuality Educators, Counselors and Therapists.

-If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

• Relationship Therapy Clients ONLY: In the Relationship Clinic, we operate with limited confidentiality. I will assume that anything you bring up with me individually is permissible to be brought into therapy unless you explicitly request that it remain private between us (where limitations 1-7 above do not otherwise apply).

Fees

In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your services. If you choose to use Out of Network rates with your insurance, we encourage you to call your insurance provider and find out what your deductible and co-pay/co-insurance is for mental health services. Your health insurance may cover all or part of the fees; you will have access to a super bill on the client portal that you may submit to your insurance company for potential reimbursement. However, you are ultimately responsible for all fees incurred. Each client is responsible for payment for services at the beginning of each session.

Please note that billing will be facilitated through STRIPE, a web-based, HIPAA-compliant billing company.

Payment for sessions will occur at time of service (debit, credit, FSA or HSA cards).

*If there has been 12 or more months since the last scheduled appointment, it is considered a new episode of care and will require a revised intake session. ** -**We charge $250 per hour for other professional services you may need, though we will break down the hourly cost if we work for periods of less than one hour. Other services include telephone or SMS conversations lasting longer than 5 minutes, consultation services, and the time spent performing any other service you may request of us. If you become involved in legal proceedings that require our participation, you will be expected to pay for all of our professional time ($400 per hour), including preparation and transportation costs and time, even if we are called to testify by another party.

-Payment for services is due at the time of service. And your receipt is available on this client portal

-You should also be aware that your contract with your health insurance company and use of your FSA/HSA/HRA card requires that if you choose to submit the paperwork to them for potential reimbursement or payment for services, you authorize us to include on your invoice information relevant to the services that we provide to you. This invoice requires a clinical diagnosis. Sometimes, we will be requested to provide additional clinical information such as treatment plans, summaries, or copies of your entire Clinical Record. This may require additional authorization. In such situations, we will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files.

About your therapist

As an interpersonal and culturally sensitive mental health therapist, my approach begins with us building a strong relationship that is based on trust, respect, and honesty. From there, we will work to replace shame, fear, and low self-esteem with self-acceptance, compassion, and a sense of personal worth and value. Our intention is for you to leave our sessions feeling validated, accepted, and challenged to face your struggles with new insights and increased confidence. My style is active, meaning that I balance listening and empathic support with gentle challenges, exercises, and ideas for maintaining your therapeutic growth outside of our regular sessions. In fact, at Wellness Lab & Clinics, we believe that much of your growth happens outside of the therapy session, so I will work to equip you with the tools and strategies you need to live life in a more present and authentic way. Some of the techniques I often use include mindfulness and relaxation exercises, communication skills, journal and letter writing, creative/artistic forms of expression, and humor.

Therapy should be a collaborative process. I will check in with you periodically about how our work is going, but I also encourage you to let me know if something is not working for you. I welcome any and all feedback about the counseling process.

Complaints

If you feel dissatisfied with our work together, I encourage you to talk about it with me in therapy. I will do my best to listen to your point of view and will try to resolve your concerns. If you feel that I have not responded in a satisfactory manner, you can also bring a complaint against me by contacting the appropriate licensing agency:

Cathi C. Stegall, Ph.D, LCSW, CST (License # L6635)

State of Oregon, Board of Licensed Social Workers

Attention:  COMPLIANCE DIVISION

3218 Pringle Road S., Suite #240

Salem, OR 97302-6310

(503) 378-5735

You may also contact my fellow colleague and contracted care provider, Dr. Sandy Newsome at (541) 371.5547 x1 for complaints or concerns.

Client Consent to Treatment

I, the client (or his or her parent or guardian), have read and understand this agreement. I consent to counseling and paying for professional services under the terms described above with Cathi Stegall and understand that I have the right to revoke this Consent to Treatment in writing and terminate therapy at any time I desire (however, please note that your provider may need to contact you for billing purposes following the formal date of your decision to revoke this Consent).

Practice Policies

Welcome to Wellness Lab & Clinics. Our practice policies outline how we deliver care, protect client rights, and maintain a safe, ethical, and accessible virtual mental health service. These policies reflect our trauma-informed, anti-oppressive, and inclusive approach and apply to all clients, caregivers, referral partners, and consultants. If you have questions or need accommodations, please contact our administrative team.

Scope of Services

We provide virtual psychotherapy, sex therapy, education, and consultation to individuals, couples, and groups across Oregon.

Services are delivered by licensed and certified clinicians with training in trauma-informed and culturally responsive care.

We do not provide emergency crisis services. If you are in imminent danger or experiencing a mental health emergency, call 911 or go to your nearest emergency room.

Eligibility and Access

Clients must be physically located in Oregon at the time of each session to receive services.

We strive to remove barriers to care. Reasonable accommodations for disabilities, language access, and accessibility needs are available upon request.

We maintain a non-discrimination policy: services are provided regardless of race, ethnicity, religion, gender identity, sexual orientation, socioeconomic status, immigration status, age, or disability.

Counseling sessions are typically scheduled for 30-50 minutes on a weekly or bi-weekly basis. It is up to you, however, to determine the length of time of your sessions. Requests to change the 30- to 50-minute session need to be discussed with the therapist in order for time to be scheduled in advance.

Therapy should be a collaborative process. I will check in with you periodically about how our work is going, but I also encourage you to let me know if something is not working for you. I welcome any and all feedback about the counseling process.

Informed Consent and Intake

Prior to beginning treatment, clients complete an intake process including demographic, medical, mental health, and consent forms.

Informed consent covers the nature and limits of therapy, telehealth technology, confidentiality, risks and benefits, fee and cancellation policies, and mandatory reporting obligations.

Clients have the right to ask questions and withdraw consent at any time; ending therapy is managed collaboratively whenever possible.

Telehealth Standards

Sessions are conducted in person or online using secure, HIPAA-compliant telehealth platforms.

Clients are responsible for using a private, quiet, and safe space for sessions and for stable internet connectivity.

Clinicians will verify client location and emergency contact at the start of each session and provide local crisis resources as needed.

Telehealth limits (e.g., when in-person referral is recommended) are explained during intake and revisited as clinically indicated.

Confidentiality and Privacy

Client information is kept confidential and stored securely in encrypted systems.

We will not disclose protected health information without written consent, except where required by law: imminent harm to self or others, abuse or neglect of a minor, elder, or dependent adult, or court order.

Communications by phone, email, or text may carry privacy risks; we will discuss preferred contact methods and obtain consent for electronic communications.

Supervisors, trainees, and administrative staff with clinical need-to-know access client information; clients are informed when students or trainees participate in care.

Record Keeping and Record Requests

We maintain clinical records in accordance with state regulations.

Clients may request copies of their records or request amendments; requests will be processed within legally required timeframes and may incur copying fees.

Billing and administrative records are retained separately as required by law.

Fees, Insurance, and Billing

Fees for services and payment policies are provided during intake and updated as needed.

We accept private pay only. Any communication with insurance carriers is the responsibility of the client.

Payment is due according to the billing agreement. Unpaid balances may result in suspension of services and, if necessary, referral to collections after reasonable notice.

Cancellations and Missed Appointments

-Therapy is comprehensive, and missing one or more sessions will interrupt the effectiveness, and the benefits may be less evident. If you miss 2 consecutive sessions, any future recurring sessions may be placed on hold until we can connect and make a new plan. After three or more months without any scheduled sessions, clients are then considered inactive.

-Please remember to cancel or reschedule 24 hours in advance.

Cancellations and rescheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time. Please note that insurance companies do not provide reimbursement for canceled sessions. *This clinic follows the Medford School District school closings schedule related to severe weather conditions or public health concerns.

Professional Boundaries and Dual Relationships

Clinicians maintain professional boundaries to protect client welfare.

Dual relationships (e.g., social, business, familial) that may impair objectivity or create conflicts of interest are avoided or managed transparently.

Clients and clinicians should discuss any potential boundary concerns promptly.

Medication, Coordination of Care, and Referrals

We do not prescribe medication; medication management referrals will be made when appropriate.

With client consent, we collaborate with other health care providers, legal representatives, or support persons to coordinate care.

When clinically necessary or requested, we provide referrals to in-person services, specialty providers, or community resources.

Safety Planning and Risk Management

When risk of harm is identified, clinicians will develop safety plans collaboratively and may contact crisis services, emergency contacts, or authorities as needed.

Clients are expected to disclose concerns that may impact safety and to follow mutually agreed-upon crisis plans.

TELEPHONE ACCESSIBILITY If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24 hours. If an emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet, and we can talk more about it.

ELECTRONIC COMMUNICATION I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee an immediate response, and I request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail, are considered telemedicine by the State of Oregon. Under the Revised Oregon Telemedicine Rules (March 2020), telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another.

If you and your therapist choose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to, improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnoses, and interventions based not only on direct verbal or auditory communications, written reports, and third-person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, observations relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), gender, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

TERMINATION Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued. Should you desire to return to therapy 12 months from your most recent session, a re-establishing intake appointment will be completed.