Consent For Service
Welcome to Harm Reduction
Harm Reduction Center is a private healthcare facility that provides highly individualized service to our clients, offering Integrated Medication Assisted Treatment and all outpatient levels of care. Ourgoal as a provider is to empower and support our client’s journey. We recognize everyone’s journey looks different and we will stand by you as you or your loved one’s walks this journey together.
Confidentiality
Policies about confidentiality, as well as other information about your privacy rights, are fully described in a separate document entitled Notice of Privacy Practices. It is the policy of Harm Reduction to protect the privacy of every client to the maximum extent possible. Generally, information about you or services furnished to you will not be released without your prior written consent. There are, however, some circumstances which require the disclosure of information without your consent, such as when:
- Mandated by state or federal law due to suspicion or knowledge of child abuse and/or neglect or elder abuse and/or neglect,
- There is an imminent risk or serious threat of physical harm to self or to others, and
- Specifically ordered by a court of law.
In accordance with the quality assurance standards set by Harm Reduction accrediting entity, your file may be reviewed to ensure record keeping compliance. Also, your therapist may anonymously discuss your treatment with a supervisor to ensure the provision of quality care. Harm Reduction Center and staff are obligated to follow laws of confidentiality.
Cancellation Policy
Harm Reduction requires 48-hour notice in the event you need to cancel or reschedule your appointment. To cancel or reschedule your appointment contact your therapist by calling his / her direct dial phone number, or you may contact the front desk at 1(866) 205-1382 between 8:30am and 4:30pm, Monday through Friday.
Emergencies
Please discuss with your therapist how to handle emergencies. If you experience a mental health crisis outside of a session there are several resources for help. These resources are available 24 hours per day, 365 days per year. Alternatively, you may go to the nearest Emergency Room or call 911.
Fees and Insurance
The fee for your first appointment is determined by a Client Service Specialist during the intake process. Harm Reduction Center accepts cash, checks, MasterCard, Discover, and Visa. Harm Reduction accepts Medicare and some insurance as in-network, and other insurance as out-of network. This varies per the individual therapist / provider, so please discuss this further with your therapist. If you select to use your insurance, we will assist you in answering basic questions about your benefits, as well as submit claims on your behalf. You will need to provide your current insurance identification care at the time of your initial appointment. Your plan may include deductibles, co-insurance, and co-pays. Ultimately, you are responsible for payment and understanding your insurance policy.
All clients of Harm Reduction Center, LLC maintain their rights to the following:
Personal Rights
1) The Client must be treated with dignity and respect, free from any verbal, physical, emotional or sexual abuse.
2) The Client has the right to have staff make fair and reasonable decisions about treatment and care.
3) The Client may not be filmed, taped or photographed unless he/she/they agrees to it.
Treatment and Related Rights
1) The Client must be provided prompt and adequate treatment and services appropriate for them.
2) The Client must be allowed to participate in the planning of their treatment and care.
3) No treatment may be given to the client without written, informed consent, unless it is an emergency to prevent serious physical harm to self or others, or a court orders it.
4) The Client must be informed in writing of any costs of care and treatment for which he/she or relatives may have to pay.
Record Privacy and Access
1) See HIPAA Privacy Practices notice.
2) Consent for Services
Grievances
Harm Reduction Center, LLC aims to provide all our clients with high-quality mental health care that will offer hope and healing. In the event you are dissatisfied with the services you or your loved one receive; you retain the right to advocate for on your/their behalf.
For clinical complaints, the procedures are as follows:
Step 1: Clients are encouraged to talk with the counselor to see if the complaint can be responded to and resolved at that level.
Step 2: If the client and counselor cannot achieve satisfactory resolution to the complaint, the client may contact the Program Director, Dan Merrill 561-374-0056
For administrative or financial complaints, the same set of procedures apply, with an additional step:
Step 3: The client may present a written statement describing the complaint to the Program Director, Dan Merrill 561-374-0056
Termination of Services
Clients have the right to end treatment at any time. Please notify your therapist of your desire to complete therapy. He/She/They may request to have a final session with you to allow for therapeutic termination and to provide aftercare planning. Services through Harm Reduction Center, LLC may be terminated for a variety of other reasons, including but not limited to: there is mutual agreement by the client and counselor to end counseling, the client does not return for counseling or reschedule for 60 days, the counselor decides to discontinue counseling because it is no longer effective or because the client does not comply with treatment recommendations, the client is engaged in residential or inpatient treatment (i.e., hospitalization) and does not expect to return to counseling.
Harm Reduction Center, LLC therapists may use their clinical judgment to determine a client needs to be referred to another clinician or to another provider organization to ensure appropriate treatment.
Harm Reduction Center, LLC reserves the right to terminate with a client who has violated cancellation policies to the point that it has become disruptive to their treatment and/or to the therapist’s schedule. Please note that clients are still responsible for making payments on all balances after they have ended treatment, no matter the circumstances. Clients are welcomed to return to treatment with Harm Reduction Center, LLC.
Client Consent
My signature below indicates that I reviewed this document, agree to the policies, and authorize the services. I accept financial responsibility for payment of services received, and for payment of late cancellations. If I use insurance to pay all or a portion of the charges, I hereby authorize the release of information necessary to process insurance claims filed on my behalf. I acknowledge that I am financial and legally responsible for the full payment of charges for services received in the event my health insurance policy does not cover my claim. I am 18 years of age or older or I have legal custody
Emergency Contact
Insurance (The office will need a copy of both sides of your insurance card).
Primary Insurance:
