Privacy Practices

Even in the absence of a verbalized threat, if your therapist or an agent of MIDDLETON PSYCHOLOGY SERVICES, LLC believes you present an imminent, serious threat of harm to yourself or another person, they will try to protect you or the potential victim (consistent with what they would expect any caring person to do, but also as required by law and ethics for therapists). This can mean inpatient psychiatric hospitalization, contacting authorities like the police, and informing potential victims.

If your therapist or an agent of MIDDLETON PSYCHOLOGY SERVICES, LLC believes a child, a senior, or a handicapped person has been or will be abused or neglected, they must report this to the authorities.

When your therapist is away, another trusted, licensed professional therapist may stand-in or be available to help should something urgent arise. She will access your records and follow the same procedures under the same constraints with regard to privacy and confidentiality.

In the interests of optimal care, your therapist will consult other licensed helping professionals, as needed. These professionals follow the same procedures under the same constraints with regard to privacy and confidentiality. When consulting, your therapist avoids using your name and limits information to only as much as is needed to communicate the treatment issue.

If you have third-party payment for services (like an insurance company), they must exchange whatever treatment-related protected health information (PHI) they require to make their payments to MIDDLETON PSYCHOLOGY SERVICES, LLC on your behalf. Your signature immediately below this paragraph authorizes them to share clinical information on your treatment with your insurance company. If you do not authorize communication of treatment-related information with your insurance company, you accept responsibility to make full and prompt payment of your bill for services provided and they will respect your wishes. Mark as appropriate below and sign next to your choice:

Be aware that should you indicate information about your treatment or receipt of services at MIDDLETON PSYCHOLOGY SERVICES, LLC on social media sites, you can never reasonably expect to retract that disclosure, even if you later remove the information from the particular site. Also, if you acknowledge your therapist in public, such as with a greeting or a wave, others may infer you know the clinician from participation in treatment (your therapist will defer direct queries by third parties and “neither confirm nor deny” your participation if asked if he sees you as a patient).paragraph here.

Regarding Telehealth and Covid-19 Precautions:

For any of a number of reasons, you may decide to participate in telehealth treatment instead of an in-person session or in addition to an in-person session. Although a relatively new means of providing services, many people describe finding the approach satisfactory. As with treatment in general, it’s important for participants to understand the risks and benefits of telehealth and fully agree to engage in this modality. Of course, they cannot anticipate all possible concerns associated with telehealth, so they ask that by your signature below, you are unconditionally accepting responsibility for any anticipated or unforeseen issues, negative consequences, or damages that might occur by virtue of telehealth services and you hold your therapist, Middleton Psychology Services, and all associates harmless now and in the future.

Even if you initially agree to participate in telehealth, you may withdraw your consent by informing your therapist and refusing to continue the service at any time.

Privacy cannot be as readily assured with telehealth as it can be in the office setting. Your therapist will establish a private location on their end, but it is up to you to ensure privacy in your setting. For instance, they recommend against planning to have a telehealth session where you set up in an area with public WiFi, such as a coffee bar. As such, participants bear the responsibility of ensuring privacy/confidentiality with regard to potential eavesdropping from others wherever you set-up your end of the connection. Likewise, they cannot guarantee anything with regard to the security of your electronic equipment (i.e., computer). If your system has been compromised in some way, as with a computer virus, they will not know that, and they cannot do anything about it. They recommend you have a good malware protection service that helps with the privacy/security of your computer (e.g., Norton, McAfee).

We use Doxy Me, a free telehealth platform, for the provision of telehealth services. Each therapist sets up an account via Doxy Me that has a unique web address for that particular provider’s “virtual waiting room.” To begin a session, patients enter the web address of their therapist’s virtual “waiting room” in their browser. Your virtual presence in the waiting room with appear on the therapist’s screen, and the therapist will then open the door to the session when they’re ready. Doxy Me serves as an independent contractor, and they do not have any control over the security of their system. They may have security breaches that compromise the privacy of your protected health information. If that happens, Doxy Me will inform them and provide options for managing the situation. They ask that you accept all risks associated with using Doxy Me.

Interacting with your therapist via telehealth will inevitably miss some important elements of in-person interactions. For instance, nonverbal communication may not be as evident.

Some insurance companies may not cover telehealth sessions. You will be responsible for covering the costs of your sessions, which are the same rates as in-person sessions, so you may want to check to see if telehealth is covered with your plan.

Important points to note with regard to telehealth services:

I understand that telemedicine/telehealth/teletherapy includes consultation, treatment, transfer of medical data, e-mails, telephone conversations and/or education using interactive audio, video, or data communications.

I understand that telehealth involves the communication of my medical/mental health information, both orally and/or visually.

I understand that there are potential risks to this technology despite best efforts to ensure high encryption and secure technology on the part of my provider and/or business associates, such as Doxy Me, including interruptions, unauthorized access, and technical difficulties.

I understand that the laws that protect the confidentiality of my medical information also apply to telehealth. As such, I understand that the information I disclose during therapy or consultation is generally confidential; however, there are both mandatory and permissive exceptions to confidentiality as discussed in their intake and delineated elsewhere.

I understand that if people other than my health care provider are present, I will be informed of this, and the others will be asked to respect privacy concerns.

I understand that my healthcare provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are inadequate for the purpose.

I accept that telehealth does not provide emergency services. If I am experiencing an emergency, I understand that I can call 911 or proceed to the nearest hospital emergency room for help.

I understand there is a risk of being overheard by anyone near me if I am not careful to ensure privacy (e.g., being in a private room). I am responsible for providing the necessary computer with audio and visual capability, telecommunications equipment and internet access for telehealth sessions, internet/computer security on my end, having sufficient lighting, and ensuring privacy and freedom from distractions or intrusions on my end.

I understand I am not allowed to make an audio and/or video recording of the tele session without the signed consent of the provider. Violation of this constraint is illegal.

Procedures for when they return to the physical office, if/when that appears indicated:

• If you are bringing your child, you will make sure that your child follows all of these sanitation and distancing protocols.
• You will take steps between appointments to minimize your exposure to COVID.
• If you have a job that exposes you to other people who are infected, you will immediately let me [and my staff] know.
• If your commute or other responsibilities or activities put you in close contact with others (beyond your family), you will let me [and my staff] know.
• If a resident of your home tests positive for the infection, you will immediately let me [and my staff] know and they will then [begin] resume treatment via telehealth.

We may change the above precautions if additional local, state or federal orders or guidelines are published. If that happens, they will talk about any necessary changes.

Their Commitment to Minimize Exposure: Middleton Psychology Services has taken steps to reduce the risk of spreading the coronavirus within the office, and they have posted their efforts on their website and in the office. Please let me know if you have questions about these efforts.

If You or Your Therapist Are Sick: You understand that they are committed to keeping you, themselves and all of their families safe from the spread of this virus. If you show up for an appointment and your therapist or office staff believe you have a fever or other symptoms, or believe you have been exposed, they ask you to leave the office immediately, and they can follow up with services by telehealth as appropriate.
If your therapist or a staff member tests positive for the coronavirus, they will notify you so that you can take appropriate precautions.

Your Confidentiality in the Case of Infection: If you test positive for the coronavirus, you may be required to notify local health authorities that you have been in the office. If they have to report this, they will only provide the minimum information necessary for their data collection and will not go into any details about the reason(s) for their visits.

For your information, their Physical Office Safety Precautions in Effect During the Pandemic include:

• Office seating in the waiting room and in therapy/testing rooms has been arranged for appropriate physical distancing.
• Their staff will use masks.
• Their staff maintains safe distancing.
• Restroom soap dispensers are maintained, and everyone is encouraged to wash their hands.
• Hand sanitizer is available.
• They schedule appointments at specific intervals to minimize the number of people in the waiting room.
• They ask all patients to wait in their cars or outside until no earlier than 5 minutes before their appointment times.
• Credit card pads, pens and other areas that are commonly touched are thoroughly sanitized after each use.
• Physical contact is not permitted.
• Tissues and trash bins are easily accessed. Trash is disposed of on a frequent basis.
• Common areas are thoroughly disinfected at the end of each day.