(Paoletta Counseling Services, Inc

Psychologists and other Mental Health Professionals have always been very protective of your private information and confidentiality. We train our office staff to also keep everything pertaining to clients confidential. Any breach of confidentiality leads to immediate dismissal of that employee from the Practice. If anything, we are overly cautious and get a dated signed release of information from you, the client, before we ever discuss or send out anything from your record. We also are very specific when we have you sign a release of information as to exactly what we are going to disclose. Details that are very private are not to be disclosed without your permission. This keeps insurance(hospitalization) managed care companies from getting this very personal and private information. Often times when you, the client, are asked to sign a blanket release of information, you are not aware of what that entity is asking for from your record. If ever you have a question as to what information they are seeking, you have the right to ask them. You also have the right to bring your concerns to our attention.

There are several exceptions to confidentiality. These are:

1) If you threaten to commit suicide and have a plan, we are obligated to inform your next of kin.

2) If you have plans of taking another person’s life, we are obligated to warn that person and the police.

3) If you are an adolescent or adult who admits to physical or sexually abused, or severely psychologically abused , we are obligated to inform CYS.

4) You are responsible for all fees that are not covered by your insurance. These fees should be paid at the time of services, unless other arrangements have been made in advance. If you do not pay your bill in a timely fashion, after two notices, you will be turned over for collection. The information we will share with the collection agency is dates of service, place of service, the amount owed as well as, your name, address and phone number.

5) If you are using insurance to pay for our services, we have you sign, initially, to release information to the insurance company, such as diagnosis, dates of service and progress. We may need to release additional information to help you obtain more sessions, but will provide the least intrusive information allowed by law. This is explained further in the more detailed HIPAA Pennsylvania Notice Form displayed in the waiting room. A copy of this notice is available to you upon request. The HIPAA Therapist and Patient Services Agreement is in the process of being revised. You will receive this agreement after revisions are completed.

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