Limits to Confidentiality and Privacy
Privacy and confidentiality are not only important to have a trusted exchange of client/ clinician information, but they are also items subject to federal law. Recovery Awareness LLC complies with federal confidentiality guidelines under Federal Confidentiality regulations (42 CFR Part 2) and the Health Insurance Portability and Accountability Act (HIPAA 45 CFR). This protection of confidentiality also specifically (42/Part 2) protects the records of mental health, alcohol and drug abuse patients, including the prohibition of re-disclosure of information from client/patient records. HIPAA also requires that mental health and substance abuse professionals provide notice to all clients that information provided by Recovery Awareness LLC and voluntarily disclosed to third parties by you (to courts, probation officers, physicians, schools, etc.) may be re-disclosed by these third parties.
Furthermore, in compliance with the aforementioned federal laws, Recovery Awareness LLC has the obligation to limit client/customer confidentiality and report specific information in the following circumstances:
Recovery Awareness LLC uses security encrypted (SSL) transmission for all professional assessment and counseling services completed online. If you choose a webcam/video/telephone service, including uploading, downloading, or faxing personal information to or from Recovery Awareness LLC, you should be aware that risk of interception of your information, though unlikely, is a possibility. Recovery Awareness client records are stored on encrypted secure servers or in secure facilities where access is limited to the professional evaluator assigned to the client and their clinical supervisors. Identifying names are not used by the evaluator if discussing client circumstances with a professional supervisor.
There is also no express or implied warranty for any client losses, damage or harm occurring from the use of electronic services, which would include: unauthorized data interception or data/records theft by a third party, unintended utility charges by a third party, computer/electronic viruses, accidental deletion of data or records, or any other claim of harm arising from your choice to engage Recovery Awareness services using electronic means (telephone, fax, internet, wireless, email, video/webcam or any other electronic delivery services that might be used in the future).
Use of Email
Unless you specifically request that your Recovery Awareness LLC assessment report or other private information be sent via mail you consent to the following:
Responsibility for Transfer of Your Records to Requesting Parties
You understand that Recovery Awareness LLC will place an official document or report signed by a credentialed professional in your online account with Recovery Awareness LLC. As noted elsewhere in this document you are responsible to review the document in its entirety before releasing it to any person or company. You may provide the official document to any requesting party at any time (e.g. court, probation officer, attorney, employer, etc.) If you would like us to send your document or report you will be required to complete a Release of Information found in your account documents.
Recovery Awareness LLC is corporation established in the state of Florida. The name "Recovery Awareness LLC" refers to the corporate entity as well as its website (recoveryawarenesscounseling.com), directors, officers, agents, employees, successors and assigns. Hereafter, registered users of the recoveryawarenesscounseling.com website shall be referred to as "you/your", "client" or "the client".
You understand and consent to treatment for professional services from Recovery Awareness. Recovery Awareness services are provided by certified and/or licensed mental health practitioners and as such may render a mental health diagnosis where appropriate and indicate such diagnoses in your written records. You also consent to the release of information for therapeutic, billing, supervision and other purposes in connection with your treatment, between and among Recovery Awareness therapists, staff and service contractors who perform supervisory work on behalf of Recovery Awareness. You understand that for a more detailed description of how your (or your child’s) health information may be released and used is contained in the current Notice of Privacy Practices. This is available on the Recovery Awareness website.
Recovery Awareness recognizes the absolute importance of keeping client records private and confidential. This section of the Agreement includes our general security practices to keep your information private:
You understand that payment for service is due before receiving services from Recovery Awareness. Additionally, you understand that Recovery Awareness has no contractual obligation with your insurance company or yourself that would guarantee reimbursement for expenses you incur for any and all services provided by Recovery Awareness.
You understand that substance use or drug and/or alcohol evaluations may include chemical tests on a case-by-case basis. In the event you are not present in our office at the time of your assessment, you may be asked to obtain an independent chemical test (e.g. urine drug screen, hair test sample, etc.) from a professional lab to present with your final assessment report. Chemical test fees are not included in the cost of your Recovery Awareness assessment and are the sole responsibility of the client.
Client Cancellation Policy and Broken Appointment Fees
You understand and agree that a fee will be charged to your account if you cancel your interview or appointment with less than 24 hours’ notice. You also understand and agree that Recovery Awareness reserves the right to cancel your service and refund your payments minus any broken appointment fees if you cancel 2 or more scheduled interview or appointment times with less than 24 hours’ notice. Broken appointment fees are $50.00 per appointment and are charged to partially offset the loss of revenue which occurs when a time has been reserved for a client but which can no longer be booked due to the short notice in cancellation.
Client Will Accurately Report Information
As a client, you agree to provide accurate information about yourself and the circumstances surrounding your need for an evaluation or counseling to the best of your ability. This includes an agreement to not omit information relevant to your situation or present inaccurate information. If inaccurate information is provided or important information is purposely omitted, you will not be eligible for a refund if your assessment is not accepted.
Recovery Awareness LLC is not a Government Entity
You understand that Recovery Awareness is not a state or federal organization. While our assessments and clinical reports are generally accepted by other professionals and government agencies you also understand that any clinical conclusions, diagnoses or professional recommendations provided by Recovery Awareness may or may not be accepted or approved by courts, state or federal agencies. Furthermore, courts, state and federal agencies are not bound to agree with our assessments or clinical recommendations.
You understand that there is a chance that internet or phone connection could be lost during your services. In the event your connection is lost, the counselor will attempt to contact you at the number you provided in your registration. If you have not heard from your counselor within five minutes, you agree to call our main number to reestablish connection and plan for continuance of your service. You also agree to hold Recovery Awareness harmless with regard to any and all claims of damage from an electronic disconnection during services (also referred to in the Hold Harmless section of this agreement).
Limited Use of Assessments
You understand and agree that professional assessments prepared for one authority (e.g. a court, a licensing agency, a child services agency, etc.) may not be accepted by another authority. For example, a state licensing agency may require a different reporting format, provider credentials, etc. than a court, therefore making a court assessment unacceptable to their agency. Accordingly, you agree to accurately represent to ndsbs.com what authority is requesting your assessment. (see refund terms and conditions) Furthermore you understand and agree that each requesting authority has their own acceptable timeframe to consider an assessment as valid. Recovery Awareness cannot be held responsible for your submission of an assessment to an authority after what the requesting authority considers a reasonable timeframe.
Respect of Copyrights
All assessment, evaluation, educational and other material made available on our website and provided in our offices is copyrighted. You may use our materials for the purpose of an Recovery Awareness assessment, counseling or education services only. You agree not to use any aforementioned Recovery Awareness materials in any other manner, including copying, reproducing, scanning, distributing, publishing, selling or otherwise conducting commercial activity with Recovery Awareness materials. Efforts to engage in such activity are punishable by state and federal laws.
You agree that you are using Recovery Awareness services at your own risk and without guarantee of any specific clinical diagnosis or treatment recommendations (education, counseling or other treatment services); that there is no warranty for our services; that third parties are not bound by any contracts or laws to accept or agree with our assessment, evaluation or other clinical conclusions.
To file a complaint with us, contact the Owner of the practice at: Recovery Awareness, 7014 SW CR 796, Lake Butler, FL 32054 (352) 440-6622 You will not be retaliated against for filing a complaint.
Acknowledgement of Receipt of Notice of Privacy Practices (HIPAA)
I acknowledge my receipt of Recovery Awareness Notice of Privacy Practices. It is included not only in this Consent for Service Agreement but is also available on our website and in our office for any client to access at any time.
Notice of Changes
Recovery Awareness may notify clients of changes or additions to its services by publishing such notice on the Recovery Awareness website. Clients may give notice to Recovery Awareness at any time by any of the following: Email: firstname.lastname@example.org Fax: 352.224.9232 U.S. Mail: 7014 SW CR 796, Lake Butler FL 32054