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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 many 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 me.

Alternative Options: There are often various treatment options: 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 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, as a Nurse Practitioner in Psychiatry and as a Psychiatric and Mental Health Nurse. I am certified by the American Nurses Credentialing Center as a Clinical Specialist in Adult Psychiatric and Mental Health Nursing. 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 in Psychology at the University of California – Berkeley, and have held previous positions as Assistant Clinical Professor in Psychiatry at the University of California-San Francisco, and as a Clinical Instructor at Columbia University.

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 generally available for psychotherapy sessions on Monday, Wednesday, Thursday and Friday between 9am and 5pm. Therapy sessions are 50 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.

One goal of the assessment/evaluation is for you and I to determine if my level of availability is suitable for your treatment needs.

In between our in-person sessions, I am available to you by telephone appointment, if you need to discuss something with me before we meet again. This is something that may be useful on an occasional basis. However, if you need more than occasional telephone contact with me between our in-person sessions, you may actually benefit from more frequent individual therapy sessions, or you may need a higher level of care. You and I will try to determine at our first meeting whether or not my availability will meet your treatment needs.

To try to get a telephone message to me urgently, please leave me a message on my voicemail (925-377-0410) stating the urgent matter and the phone number where I may reach you. When you have finished leaving me a voicemail message, press the "4" key. This will place your message at the top of my voicemail queue and will send a text message to me telling me to check my voicemail.

I usually check my voicemail messages at least twice per day, often more frequently. I will respond to your call as soon as possible upon receiving the message, usually within a few hours or less on weekdays and usually within 12 hours or less on weekends.

I do not have hospital admitting privileges, do not prescribe medication and am not available on an emergency basis.

For medication emergencies:
Call your prescribing physician or 911, or go to the nearest ER

For other emergencies:
Call the Contra Costa Crisis Team at 1-888-678-7277 or 911, or go to the ER

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@comcast.net 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 $175 for a 50 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 25 min. phone session or 1/2 of 50 min. is charged as 1/2 of $175 = $87.50)

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 48 hours advanced notice of a cancellation of an appointment and will usually charge you for a cancelled appointment that I am unable to fill.

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 Psychiatric and Mental Health Nurse-Clinical Nurse Specialist 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
 

Signatures of Client:

I have reviewed and understand Lynn Martin's Policy Statement.
 

Signature: _____________________________ Date: ___________

Printed Name: __________________________________________




Option for 2nd Opinion/Consultation – Only sign one of these options:

___ Option #1 (Give Permission):  I DO give Lynn Martin my permission to discuss my clinical situation with colleagues at her two colleague consultation seminars, without giving them my name of other identifying information about me.  The purpose of this is for Lynn Martin to enhance my treatment by obtaining a 2nd opinion/consultation about me.  This possible 2nd opinion/consultation is free of charge to me.

Signature: _____________________________ Date: ___________

Printed Name: __________________________________________

 

OR

 

___ Option #2 (Decline Permission):  I DO NOT give Lynn Martin my permission to discuss my clinical situation with colleagues.

Signature: _____________________________ Date: ___________

Printed Name: __________________________________________