Green House Group, P.A.

Psychological and Consultation Services

Waumbec Mill, 250 Commercial St., Ste. 3004
Manchester, NH  03101-1118  603-668-3050

INFORMED CONSENT AND PRIVACY PRACTICES

The Clinical Relationship

All clinicians at Green House Group, PA are licensed by the NH board of Mental Health Practice, and practice in accordance with the professional and ethical guidelines of that Board and appropriate national professional organizations such as the American Psychological Association and National Association of Social Workers.  Your clinician will answer any questions regarding his/her professional credentials, as well as regarding your diagnosis.  If you wish, you may have access to clinical assessment results as provided by legal and professional guidelines.  Treatment recommendations with rationale will also be explained, as well as the rationale if no treatment is recommended.  Green House Group, PA provides twenty-four (24) hour emergency telephone service coverage to current clients, which may be accessed via instructions on our telephone answering message.
Privacy Practices

The confidential relationship and communications between a licensed mental health professional in the State of New Hampshire and his/her clients are privileged, and communication will not be disclosed except for the following provisions:

1)     If the client requests and agrees in writing to such disclosure;

2)    As professionals we are required to report to state authorities any instances of reported, observed, and/or suspected abuse of children, the elderly, or handicapped adults;

3)    Under provisions of NH laws (RSA 330-A: 22), therapists have a duty to "warn of, or take reasonable precautions to provide protection from a client's violent behavior when the client has communicated to the mental health professional a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims, or a serious threat of substantial damage to real property."  Every reasonable effort will be made to communicate a threat to the victim(s), the local police department or to "obtain civil commitment of the client to the state mental health system."  This also applied to incidents of possible harm to self.  If such efforts are made, the mental health professional is not liable for any legal action for having broken the privacy or confidentiality of the therapist-client relationship;

4)    Should a Court Order require such disclosure;
5)    State regulatory agencies (e.g., New Hampshire Board of Mental Health Practice) have a legal right of access to client records when and if a questions of professional misconduct is raised;
6)    When you agree to have us bill your insurance carrier for services, the insurer or their designated representative does have access to your record for review purposes.  Unless you otherwise indicate, you release Green House Group, PA to provide only billing information to the subscriber of any  insurance, if the subscriber is other than yourself (e.g. divorced spouse who carries insurance coverage on your children).
7)    If the individual receiving treatment is under eighteen years of age, treatment must be authorized by a parent or guardian (with limited exceptions).  It is our preference to undertake treatment only with the consent of both parties.  If we determine that it is appropriate or necessary to proceed with therapy with only one parent providing consent, the non-signing parent still has a legal right to a copy of the minor's record if requested, unless his/her parental rights have been terminated, there is a Court Order prohibiting him/her from receiving records, or if it is determined through professional judgement, within the confines of applicable case law as decided by recent Supreme Court decisions, that examination by or release of the minor's clinical record to the parent(s) is not in the best interest of the minor.  It is our policy to request an agreement from parents that they agree to give up access to the adolescent's records and/or provide them only with general information about our work together, unless we were to believe there is a high risk for serious harm to themselves or another.  In this case, we would notify parents of our concern(s).  Before giving parents any substantial information, the therapist would discuss the matter with the adolescent, if possible.
8)    Lastly, I/we agree never to issue a subpoena or formal request to my therapist or GHG intended for use in any family court-related dispute, for any reason.  This would include any expectation that my therapist(s) might act as a witness for or against myself; or if a couple, for or against either person receiving services through the Green House Group, PA.
Privacy Practices and HIPPA
Health Insurance Portability and Accountability Act (HIPAA) is a new federal law that provides privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) for purposes of treatment, payment and health care operations.  (That is, your case file).  HIPAA requires you be provided with a Notice of Privacy Practices for use and disclosure of PHI for such treatment payment, and health care operations.
Protected health Information may not be used or disclosed in violation of the HIPAA Privacy Rule (45 CFR parts 160 and 164) (the "Privacy Rule"), or in violation of state law.  As a clinician, we are permitted, but not mandated, under the Privacy Rule to use and disclose PHI without patient consent or authorization in certain circumstances.  However, state or federal law may supersede, limit, or prohibit these uses and disclosures.
Such permitted uses and disclosures of PHI include:  Those made to the patient, for treatment, payment, or health care operations purposes, or as authorized by the patient.  Additional permitted uses and disclosure include those related to or made pursuant to reporting on victims of domestic violence or abuse, as required by law, Court orders, Worker's Compensation laws, serious threats to health or safety, government oversight (including disclosures to a public health authority, coroner or medical examiner, military or veteran's affairs agencies, an agency for national security purposes, law enforcement).  We use and disclose PHI only as permitted by the Privacy Rule and in accordance with state or federal law.
The law also requires that your signature be obtained, acknowledging that you have been provided with this information.  Although these documents are long and sometimes complex, it is very important that you read them carefully.  You can discuss any questions you have about the procedures upon meeting with your therapist.  When you sign this document, it will represent an agreement between yourself and your clinician.  You may revoke this Agreement in writing at any time.  That revocation will be binding unless action has already been taken in reliance on it or if there are obligations imposed on Green House Group, PA by your health insurer in order to process or substantiate claims made under your policy.
You should be aware that, pursuant to HIPPA, your clinician will keep Protected Health Information about you in two sections of the professional record.  One set constitutes your Clinical Record.  It includes information about your reasons for seeking therapy, description of the ways in which your problem impacts your life, diagnosis, goals for treatment, your progress towards these goals, medical and social history, treatment history, any past treatment records that were received from other providers; as well, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier.
In addition, your clinician also keeps a set of Psychotherapy Notes.  These Notes are for their own use and are designed to assist in providing you with quality treatment.  While the contents of Psychotherapy Notes vary from client to client, they can include the contents of conversations with your therapist.  They also contain particularly sensitive information that you may reveal that is not required to be included in your Clinical Record.  These Psychotherapy Notes are kept separate from your Clinical Record.  While insurance companies can request and receive a copy of the Clinical Record, they cannot receive a copy of your Psychotherapy Notes without your signed, written Authorization.
HIPAA also provides you with several new or expanded rights with regard to your Clinical records and disclosures of Protected Health Information.  These rights include requesting that your clinician amend your record; requesting restrictions on what information from your Clinical Records may be disclosed to others; requesting an accounting of disclosures of Protected Health Information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about Green House Group, PA or the clinician's policies and procedures recorded in your records; and the right to a paper copy of the Agreement, the attached Notice form, and Green House Group, PA privacy policy and procedures.  Your clinical record will be confidentially treated and maintained as required by law.  We have established guidelines within our practice for clinical record management should death or disability of the clinician occur.
Further, it is our understanding that insurance companies cannot require your authorization as a condition of coverage nor penalize you in any way for your refusal.  You may examine and/or receive a copy of your records if you request it in writing; in the case of minor/unemancipated children, the health care provider may choose not to disclose or provide access of PHI to a parent if doing so is prohibited by an application provision of State or other law (e.g. if releasing a minor's clinical record is professionally determined to be contrary to the minor's best interest).  Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers.  For this reason, it is recommended that you initially review them in the clinician's presence, or have them forwarded to another mental health professional so you can discuss the contents with such assistance.  There is a charge of $ 15.00 or .50 per page, whichever is greater, for requests to copy records.
Lastly, Green House Group, PA has contracts with various businesses in order to conduct clinical and business services, such as emergency telephone answering services.  As required by HIPAA, we have a formal business contract with these businesses in which it is agreed each will maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law.  If you wish, the names of these organizations and/or a blank copy of this contract can be provided to you.