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POLICY STATEMENT
This document contains information about my professional services, business policies and confidentiality policies. Please read it and discuss any questions/concerns you have with me.
Assessment and Treatment: I will provide an assessment of your difficulties and available treatment options. If I recommend and you agree, I will provide psychotherapy for you. I will provide rationale for the psychotherapy approach or other treatment options I recommend for you. I will try to provide an estimate of the number of treatment sessions that it will take to achieve your treatment goals, although this is only an estimate. For most patients, treatment may range from 10 to 50 sessions. No guarantees can be made regarding the success of treatment. There is a small risk that your condition may worsen during treatment. Treatment can be time consuming and stressful. It can bring up many strong feelings. It may result in changes that were not originally intended. Treatment decisions for you will be made collaboratively, between you and I.
Alternative Options: There are often various treatment options, such as various individual psychotherapy approaches, group/couple/family/self-help therapies, medication treatment, etc. Testing and other diagnostic procedures may be helpful in some cases. I may recommend or you may wish to explore treatment options other than treatment with me. You are entitled to ask questions about all aspects of treatment. At times, I may recommend that you obtain a 2nd opinion or consultation with another professional. I will tell you my rationale for any treatment recommendations I make for you.
Training and Experience: I am certified by the Academy of Cognitive Therapy as a Cognitive-Behavioral Psychotherapist. I am also licensed and certified by the State of California as a Registered Nurse and as a Nurse Practitioner in Psychiatry. I have been a practicing psychotherapist since 1988, and have worked in clinical psychiatry research and treatment settings since 1979. Since 1984, I have specialized in the treatment of anxiety and mood disorders. I am currently an Assistant Clinical Professor at the University of California - San Francisco Department of Psychiatry where I teach Cognitive-Behavioral Psychotherapy.
The Patient's Role: You are expected to play an active role in your treatment with me. This includes working with me to outline treatment goals, and includes completing symptom assessment questionnaires to monitor your symptoms. You will probably be asked to complete homework assignments between sessions. If at any point you are unhappy about the progress, process or outcome of your treatment, please discuss this with me so that we may attempt to resolve any difficulties and arrive at a treatment plan that better meets your needs.
Hours/Availability: I am available for psychotherapy sessions on Monday, Wednesday and Thursday between 9am and 4pm. Therapy sessions are 45 minutes. Sessions typically occur 1-2x/week during the initial phase of treatment, and may taper to 1-2x/month during the final phase of treatment. I will discuss my recommendation for frequency of sessions with you after I complete the assessment/evaluation of your treatment needs. The first goal of the assessment/evaluation is to determine if my level of availability is suitable for your treatment needs.
I am available by pager at 925-955-5022 for established clients with urgent situations. Possible reasons for paging me will be discussed with you. I do not have hospital admitting privileges and do not prescribe medication and therefore am not available on an emergency basis. Again, an important part of the assessment/evaluation is to determine if my level of availability is suitable for your treatment needs.
Confidentiality: The confidentiality of communication between a client and a therapist is important. Your confidentiality is protected by HIPAA (Health Insurance Portability and Accountability Act) Guidelines (1996), enclosed. I will make every effort to keep information regarding your evaluation, diagnosis and treatment strictly confidential, as is required by law. A document entitled "Consent for Release of Information" must be reviewed and signed by you in order for oral, written or electronic information about you to be released by me to any other person or agency (other than co-treating providers). I prefer to use the U.S. Postal Service or telephone to communicate with other providers about your clinical care. This avoids the possible risk of breaching confidentiality via internet communication.
You and I may decide to e-mail each other as part of your treatment plan. E-mail updates between sessions often help clients to complete homework assignments, but pose some risks regarding confidentiality. If we decide to communicate via e-mail, we will review a document entitled "Consent for E-mail Communication". You must sign the document in order for us to communicate via e-mail, but have the right to refuse or restrict e-mail communication with me. My e-mail address is martincbt@attbi.com and is secured by a password known only to me. To the best of my knowledge, I am the only person who can read mail at this e-mail address.
Exceptions: Information CAN be released WITHOUT your permission if:
*You are a danger to yourself or others, or are unable to care for yourself.
*There is suspected elder, dependent-adult or child abuse/neglect.
*I am ordered by a court to release information.
Record Keeping: I maintain a clinical chart of handwritten notes for each patient. Information in this chart includes your name, contact information, diagnosis, description of your condition, treatment goals, treatment plan, dated progress notes from each session, symptom monitoring forms, and consent for release of information documents. These records are stored in a locked file cabinet.
I may have a written evaluation about your history, current symptoms and current treatment in my computer file. My computer file is secured by a password known only to me, and is therefore inaccessible to anyone else.
Consultation with Colleagues: I participate in two colleague consultation seminars. I may want to discuss your clinical case (without your name or other identifying information) with my colleagues for the purposes of enhancing your treatment. This allows me to obtain a 2nd opinion about your diagnosis and/or treatment that is free of charge to you. I would like your permission to discuss your case (confidentially and anonymously) with my colleagues, but you may refuse without any negative consequences.
Fees: My fee is $150 for a 45 minute session. Longer or shorter sessions will be pro-rated from this fee base. Phone calls will also be charged at pro-rated fees according to the length of the call. (ex. A 15 min. phone call or 1/3 of 45 min. is charged as 1/3 of $150 = $50.00)
Session Location: Most sessions are conducted in my office. However, certain symptoms require that treatment will be conducted outside of my office. If this applies to you and your symptoms, I will discuss it with you directly. I discourage the use of telephone sessions because they are usually inadequate. Between-session phone contact is also discouraged, and often indicates that the client needs more frequent in-person sessions as part of their treatment.
Cancellation: I would greatly appreciate 24 - 48 hours advanced notice of a cancellation of an appointment. I usually charge you for a cancelled appointment with less than 24 hours notice, if I am unable to fill your cancelled appointment time. The earlier you notify me of the cancellation, the more likely it is that I will be able to offer your time to someone else and not charge you for the cancellation.
Payment: Please pay me at each session. I prefer to have clients pay me directly and collect from their insurance companies themselves. This allows you to have control over the information released to your insurance company without involving me.
Billing: I will give you a billing statement in each new month for the previous month. This bill includes a diagnosis code(s), clinical services code(s), dates of service and payments made. It also includes information the insurance company requires about my license and credentials.
Insurance Reimbursement: I am not a preferred provider on any insurance plans. If your mental health coverage allows you to choose any provider, they may cover my services. I am a California State Licensed and Certified Nurse Practitioner in Psychiatry and an Academy of Cognitive Therapy Certified Cognitive-Behavioral Psychotherapist. I specialize in the cognitive-behavioral treatment of anxiety and mood disorders. Please call your carrier directly to inquire about their coverage for my services.
If you have any questions about the above information, please discuss them with me.
Thank you for your interest in me as a possible provider of mental health treatment for you.
Lynn Martin
Signature of Client:
I have reviewed Lynn Martin's Policy Statement.
Signature: _____________________________ Date: ___________
Printed Name: __________________________________________