The information below contains information about the practice of
Kurt LaRose MSW LCSW CHT CSW Supervisor and LICSW for the Secure
Client Area @ TalkifUwant.com. It is necessary for all users
to read, review, and accept these terms to begin services with the
practice. Please know that you are providing the practice
with certain consents regarding billing, private health
information, and obligations that are contractual and or required
by certain standards of care and various mandates that govern
mental health, behavioral health, clinical supervision, hypnosis
and consultation services - between you and the practice of LaRose.
If you are seeking services with the practice as a NEW PATIENT,
CLIENT, INTERN, or PEER, the practice is currently ACCEPTING NEW
PATIENTS in for DIGITAL based SESSIONS (Chat, Video, Journal,
Secure Email, File Sharing and Phone) for patients who are
SELF PAY. At this time office face to face and onsite
sessions are not offered.
Specialty services, online options, and hypnosis sessions are
offered for residents of Missouri, Washington DC and Florida. All
parties seeking services with LaRose are served using multiple
formats, however face to face sessions are not offered.
Video/chat/telephone/shared journal and narrative digital formats
using this secure server are available with asynchronous options
available 24 hours a day (replies can be delayed, however
generally occur with 24 hours).
New persons/clients will be asked to identify if they are a
Florida Resident, a DC Resident or a Missouri Resident upon
logging in to this secure server. A valid ID will be
required as an upload, as is a credit card, prior to being able
to use the services in the digital server. At that time the
calendar will be available for you to schedule (depending on if
your request is a scheduled one or an asynchronous one) after you
identify what services you are seeking and your reasons for
seeking services.
Only self pay clients are being seen by the practice of LaRose
and all services are available in digital and remote only
options.
Supervision candidates (those seeking licensure supervision will
be directed to alternative scheduling platforms after the initial
consultation) where online supervision hours can/will occur (if
face to face options are not available then supervision services
cannot be offered due to licensing board requirements which this
can be discussed upon inquiries).
THE NAMED CLIENT/PERSON WHO IS BEING TREATED/SUPPORTED BY THIS
OFFICE, WHEN THE CLIENT IS 18 YEARS OF AGE OR OLDER, IS THE ONLY
PERSON WHO CAN LEGALLY AGREE TO THESE TERMS AND COMPLETE THE
DIGITAL APPLICATION PROCESS. MINOR CLIENTS ARE NOT BEING
ACCEPTED BY THE PRIVATE PRACTICE AT THIS TIME
By giving your consent below, you are stating that you are the
client and by digitally signing below, you as the legally named
party (the client or the medical guardian on behalf of another
adult client), agree that you have read this information and that
you are providing your legal consent related to each of the
following sections:
===> CONSULTATIONS
===> REGISTRATION, SECURITY &
CONFIDENTIALITY.
===> RECORDS STORAGE, CLIENT UPLOADS &
REQUIRED CONSENT TO RELEASE.
===> AUTOMATIC ELECTRONIC INVOICES & TERMS
OF VALIDITY.
===> USPS PAPER INVOICES AND DISPUTES.
===> FEES, PAYMENTS, REFUNDS, COLLECTIONS,
CREDIT BUREAUS and BILLING AGENT.
===> NEWS
===> FACE TO FACE and ONLINE INCLUSIONS and
EXCLUSIONS DUE TO REGULATIONS.
===> NON-24 HOUR CANCELLATION POLICY.
===> ACCOUNT ADJUSTMENTS.
===> MENTAL HEALTH ONLINE, SAFETY,
CONFIDENTIALITY AND RELEASE OF RECORDS, LICENSING, and MALICIOUS
BREACH.
===> ONLINE AND SOCIAL MEDIA PRESENCE,
CLIENT REVIEWS AND DIGITAL ETHICS DISCLOSURES.
===> ANNUAL RENEWAL FOR BILLING PRACTICES,
HIPAA, AND POLICY UPDATES AUTHORIZED BY USERS
===> ONSITE SERVICES, ON LOCATION SERVICES,
SUPERVISION, PROVIDER DEVELOPMENT, CONCIERGE AND ANNUAL RETREAT
SERVICES
REGISTRATION, SECURITY & CONFIDENTIALITY. All client records
are stored and maintained via the secure digital profile, thus
your site registration is necessary to facilitate and manage
electronic health records. Confidentiality, Federal HIPPA and
State Privacy Standards, as well as encrypted and password
client/therapist communications all make the 2 - 3 minutes to
sign up - well worth it.
CONSULTATIONS. Initial sessions are billed to the card on file
(unless a special arrangement with LaRose is made or
offered/chosen); these can occur by video, by chat, by telephone,
secure email and journal options with some services offered
synchronously and others asynchronously.
For initial consults clients of MO, DC, and FL will need to
upload their photo ID's and show they may need to show their
credit card (for verification purposes of the name and the last 4
digits of the credit card and to establish residency where LaRose
is licensed to treat) during the consultation.
All appointments can be scheduled here in the server, 24 hours a
day! Text reminders of the sessions are sent 24 hours in
advance, along with email reminders and a phone message
too. Clients may cancel their sessions in the server PRIOR
TO A 24 HOUR WINDOW to avoid a non 24 hour cancellation
fee.
RECORDS STORAGE, CLIENT UPLOADS & REQUIRED CONSENT TO
RELEASE. Most people know that mental health professionals gather
information related to personal experiences and histories.
Private journals, uploading of diagrams, photos, or scanned
drawings, and secure emails make the client portal an ideal
platform. Encrypted case notes, client notes, insurance
information, intake forms and billing records are available for
online updates 24 hours a day. Except in specific legal scenarios
(safety, court order, regulatory investigations, and in some
third party contract terms) your private health information is
protected unless/until you give written consent for release. In
certain scenarios "privilege" is exercised with your records even
with written consent, meaning the information may not be released
without properly served subpoena and/or court order when served
to LaRose.
AUTOMATIC ELECTRONIC INVOICES & TERMS OF VALIDITY. Electronic
invoices email 24 hours before your date of service (or at the
starting time of the session). Appointments booked UNDER 24 hours
will likely receive an INSTANT electronic invoice. In all
scenarios where services occur, there is billing time associated
to that time; if you are unsure of the cost you should ask.
Minute by minute billing can occur in some instances; in
others a flat fee is billed and yet in others there is a one fee
for 60 minutes of services. A balance due is realized
(subsequent to any and all electronic invoicing) and if needed
the electronic billing will be adjusted at the time costs changes
are realized (such as time that runs over or at the time a non 24
hour cancellation has occurred).
All balances are due at the time of service and/or at the time
the fee is realized; balances are billed to the credit card
clients provide in the server (the card must be in the name of
the client). The credit card is required upon setting up
appointments and in accessing the client portal (credit card data
is stored encrypted and cannot be fully accessed by LaRose once
you enter it - except to the degree needed to electronically
process the credit card and in accordance with credit card
storage rules). Invoices are no longer mailed by
traditional USPS mail; electronic copies can be printed in the
server at anytime (or printed to a PDF and emailed by clients who
choose to do so).
All amounts due are billed at the current practice rate (see
FEES... below for additional information).
INVOICES AND DISPUTES. Subsequent to any applicable adjustments,
if a payment cannot be processed with the credit card on file, a
secure email notice will be sent requesting the client update the
card to a working card; also a text will be sent requesting an
updated card to the cell/texting number your provide (personal
email addresses and personal cell phone numbers are required to
ensure your privacy). If a paper invoice must be mailed
through the United Postal Service, they are mailed to the clients
address as it is/was provided by the client at the time of
scheduling (or as updated in the server). Any USPS mailed invoice
is due upon receipt.
Disputes must be noticed to LaRose as soon as they are realized
by sending a secure server email (logging into the server)
outlining the concerns and the request for resolution.
LaRose does not offer refunds or guarantees as this cannot be
ensured in social services and professional talk therapy based
services.
Late payments, unless a financial arrangement is agreed upon and
recorded by joint signatures, are reported to credit bureaus (see
FEES, THIRD PARTY PAYOR, PAYMENTS, REFUNDS.... for more
information). Credit card payments in the server will
prevent time and energy and money in collections, thus the
practice will resolve account balances immediately upon the start
of all sessions.
FEES, PAYMENTS, REFUNDS, COLLECTIONS, CREDIT BUREAUS and BILLING
AGENT. Payments may be made online. All fees and payment terms
are discussed here and all questions involving these practices
should be discussed during your initial consultation and/or
inquiry.
Clients are encouraged to ask and to discuss any concern they
have in this regard as the terms of this agreement is the final
word on how such matters are handled and resolved. Fees for the
initial consultation will be charged to the card on file at the
start of the session or prior to the agreed upon service
beginning (usually agreement will be requested in the secure
server email platform so that you and LaRose both have a record
to access about what is agreed upon).
The amount you agree to pay or that you are responsible to pay is
collected at the time of service. The full hourly rate is
currently $155 per hour, unless a group package or specialty
service is/has been requested. Additional service options,
special rates, concierge services, and non-specialty services
such as hypnosis, minute by minute options with each related fee
structure is available at
https://TalkifUwant.com/prices_fees
In the unlikely event billing agents, collection agencies, credit
bureaus and in extreme cases legal counsel are involved to
resolve balances, please be aware that the name of the
client/person working with LaRose is identified as a client and
when necessary it will include the release of the social security
number, date of birth, mailing address, ID numbers and phone
numbers, as needed to effect collection and to record
delinquencies. These actions are seldom a factor in the
practice as outstanding billing seldom occurs in the use of
server technologies. Because the practice includes an
automated billing and a credit card processing platform
collections are seldom necessary, particularly as and when
clients/persons working with LaRose keep the credit card profile
up to date. At times LaRose may ask to update a non-working
or declined card prior to proceeding in service provisions.
NEWS. All patients and clients who are new to the practice and/or
who are considering services with the practice have been notified
to read the NEWS tab (click the question mark icon above)
regarding actual and anticipated changes involving expanded
services, professional biography information, client reviews and
various videos related to the practice service and services
availability. Links to these and other relative topics are
listed in the NEWS section of the server, and these can be
reviewed PRIOR to or AFTER this registration is
completed.
The practice of LaRose is currently accepting new
patients/clients who are SELF PAY, and who wish to be seen via
remote services, and digital services, including video, chat, and
telephone (via this HIPAA compliant secure server); not all
session types are available and as such limited service options
occur and these change from time to time.
Florida, DC and Missouri patients/clients/supervisees can access
online services 24 hours a day, with digi-mental health services
(video/chat/telephone/Shared Journals and Narrative approaches)
scheduled based upon calendar availability. Face to face
and onsite scheduling options are not currently available.
Service options can be selected upon completing the initial
registration and based on available service options
offered. Special appointment requests are handled when
clients send secure emails (in this server) requesting such (as
certain communications cannot occur in a public domain email
process).
In certain scenarios LaRose will schedule an office session
however since LaRose is currently 100% online for the private
practice this option may not be available due to remote
services. Since the practice is transitioning to a fully
digital platform (currently anticipated for an extended and/or
possibly an indefinite period of time) and as the services are
license regulated to a residents of a three state area (where
LaRose is licensed in Missouri, Washington DC and in Florida)
creativity and unique digital services options are offered.
FACE TO FACE and ONLINE INCLUSIONS and EXCLUSIONS DUE TO
REGULATIONS. LaRose is licensed to provide traditional talk
therapy, clinical hypnosis and clinical supervision services in
accordance with the licensing board standards in three
jurisdictions, FL, DC and MO. Digital services, as an
emerging area of practice, in both therapy to client and
supervisor to supervisee (in licensure scenarios), has benefits
and limitations and current regulatory bodies are significantly
behind client demands; that is to say that while you may want to
access digital services with the practice (such as supervision),
you can only access such services if you are an actual resident
of the same states where LaRose is licensed to practice in his
areas of expertise FOR ONLINE SERVICES and where licensing rules
allow for such services.
Licensing boards in the US do not currently have a universal 50
state credential and licensing fee structure to provider online
services across jurisdictions. If you are resident of MO,
DC or FL and you wish to have video/chat/telephone and other
online services you may do so at any time. If face to face
services were an option, you could go into the office of the
provider (regardless of your residency) and be treated; face to
face options are not currently available with the private
practice of LaRose.
NON-24 HOUR CANCELLATION POLICY. LaRose assesses fees for
no shows and non-24 hour cancellations (without a documented
medical or legal document) when the cancelled spot cannot be
filled by someone else. If clients must cancel less than 24
hours, they will have to contact LaRose via secure server
email/text as soon as they know they need to miss (if a client
text LaRose, they are advised that this is not considered a
confidential form of communication and there is a risk of
disclosure of information outside of the control of LaRose; use
of the secure server is recommended; in urgent matters a text
could say "please check the server for an email".
LaRose will have to cancel a session when it is going to be
missed with less than 24 hour notice if that is what is requested
(online services have fewer cancellations since services can be
done remotely) - so clients will have to directly notify LaRose
to cancel when it is requested late.
When appointments or services are cancelled prior to the 24 hour
notice window, clients may do so at will in the server, without
notification to the office of LaRose - and fees are not
assessed. Clients are encouraged to cancel sessions online
as soon as they know they cannot be seen and will be able to do
so freely in advance of the 24 hour notice. LaRose will
make every effort to fill a non-24 hour cancelled spot, however
except in medical and legal documented scenarios the no show fee
is assessed and charged to the card encrypted in the
server.
Cancellations prior to the 24 hour window, are the responsibility
of the client, completed by clients using the online scheduling
platform in the server. The fee for non-24 hour
cancellations is assessed at a reduced fee of $90 when requested,
otherwise the cancellation fee is equivalent to the current
hourly fee of $155. Deposits on hypnosis sessions, onsite
services, and preplanned retreats cannot be refunded due to
cancellations as numerous hours and scheduling adjustments are
made to effect these specialty services.
Payments, Refunds, Collections. All amounts due via electronic
notification are billed until payment is received. At 30 days
electronic billing may be transferred to a billing agent for USPS
invoicing and collection procedures. The practice of LaRose
reserves the right to file any past due amounts with the billing
agent, collections agencies, and credit bureaus. Billing
with the practice of LaRose may continue into perpetuity, or
until such time as the balance is satisfied, due to the nature of
automated online digital technology, or until and as limited by
state and federal laws, if applicable. Use of the credit
card platform in the server prevents these steps from needing to
be engaged, however, if for some reason a payment is not
processed/collected or it is charged back, LaRose will engage the
collections process as you (the client) are agreeing to this
collections and non-charge back term herein.
All person's using credit cards to make payment for services
agree NOT to pursue charge backs because social service
technology and information (therapy, counseling,
psycho-education, communication based services and interventions)
are non-refundable. In the event a refund is requested (if LaRose
denies the refund request), or if a charge back is issued or a
stop payment/returned check occurs, the original fees and all
subsequent fees as a result chargeback or stop payment actions
will remain due (and may increase the overall costs) as the
financial responsibility of the client (which you are now
agreeing to).
Charge backs, refund requests, stop payments on checks, returned
checks and denied credit card payments will be referred to the
billing agent for traditional collection procedures as soon as
the office of LaRose is notified of such stop payment actions.
If/when necessary the office of LaRose (and the services offered
through the Talkifuwant secure portal) are forwarded to credit
bureaus; once an account is transferred to a credit bureau,
settlement and payment arrangements must be arranged with the
appropriate bureau (they are not resolved with the practice once
the matter reaches a bureau or collection agency).
Clients agree that if there is a fee dispute to resolve the
matter with the practice. Because fees are non-refundable,
all efforts to stop payments as they are agreed upon here, are
referred to collections, based on this agreement. This is
your (the client) agreement to pay for all services as outlined
in this initial and online consent, effective for all services
rendered for the duration of any amounts due, up to and until
payment is received (even in perpetuity in cases where
non-payment occurs and in cases where the law permits "in
perpetutity" collections).
Billing Agency & Credit Bureau Procedures. A third party
billing agency may assist the practice of LaRose with billing
practices when USPS services are initiated, and only the
information necessary to facilitate billing and collection is
released to effect collections. In cases where collections are
referred to credit bureaus, the referral is labeled as
"professional services" provided to a client name, address, ID
information, and social security information (needed at
registration in the event of non-payment for the purposes of
registering to credit bureaus where default occurs) and the
practice of Kurt LaRose MSW LCSW is named as well in the
collections process. Credit bureau reporting may have negative
financial implications, thus clients are encouraged to determine
acceptability of the services offered in the initial
consultation. This is your (the client) agreement to pay for all
of the costs for the services incurred by you (up to and
including any costs added during a collections process).
Hardship Fee Reduction Agreements and Discount Options for
Fees. If, after starting services with the practice,
clients experience a hardship, and you (client) cannot afford the
services provided by the practice, due to an inability to pay,
reduced fee agreements can be requested based upon verifiable
income, verifiable hardship, and a credit report requested by the
practice on your behalf. Hardships can and do occur in the
course of therapy, and when documented and evidenced, the
interruption of care is NOT recommended; it is in these scenarios
where fee reduction agreements become an option.
Clients who wish to obtain a discounted fee, not as a hardship
but as an option in the bundling of services, are able to obtain
a lower rate if they pre-purchase set numbers of sessions or
packages (see TalkifUwant.com/prices_fees for the breakdown of
packages) and when prepayment occurs. These discounted
packages are a "use it or lose it" package; for example, if
clients purchase 24 sessions for a calendar year with a
discounted prepayment fee and the client only uses 20 of them,
the remaining 4 sessions expire at the end of the 12 month
term.
ACCOUNT ADJUSTMENTS. Credits and debits will be made
electronically as they are realized to the client online secure
billing profile, and any adjustments will be explained in a
secure email in the server to the client. Any credit posted to
the digital billing profile where a credit on the account balance
is realized (in the event of automated electronic billing errors
or when an over payment occurs) are refunded upon request of the
client (or when realized by the practice using the card that was
used at the time of the fees were assessed). In some cases the
credit cannot be applied to a card on file (for a number of
scenarios related to the merchant account and the server gateway)
and in such cases a paper check will be mailed to the address on
file in the secure server. The digital billing profile is
accessible in the secure client area of the TalkifUwant.com
website - 24 hours a day and clients agree to check the billing
profile once notifications of fees and credits occurs; clients
may elect to make payments (by clicking one button) in the
billing profile and it is in the billing profile invoices and
receipts can be printed by clients.
MENTAL HEALTH ONLINE, SAFETY & 911, LICENSING, and MALICIOUS
BREACH. Online communications in mental health service delivery
is considered a non-traditional form of service. National
Professional standards, specific legal limitations, and matters
involving aspects of online communication that are not a factor
in face-to-face sessions require consent. Clients using
such services acknowledge that these services are still, in 2021,
considered non-traditional. Confidentiality, for example,
in a digital based session cannot be managed ONLY by the
therapist; clients assume a responsibility in ensuring their own
confidentiality during video/chat/telephone/secure email/shared
journaling, and by NOT sharing their user names and passwords
related to the secure server. Other examples include the
difficulty in determining safety if/when a video or chat session
is interrupted (either by the client or by an act outside the
control of the client and LaRose) and if in the course of a
session safety risks are realized and cannot be determined in
real time wellness checks are used to determine client safety (a
wellness check involves having law enforcement visually determine
if a questioned safety concern is resolved). Further, in
chat sessions (or all other digital mental health services) it
can be difficult to accurately read a situation with a client
since the client is NOT face to face with the therapist.
Innuendo related to violence by journals and secure emails are
strongly discouraged as asynchronous informational access (time
lapses between the time it is recorded and when it is reviewed)
may require immediate response time once a possible risk of harm
is realized.
Online mental healthcare is a specialty practice. LaRose
has self published on the online digital services model in 2012,
and was using digital mental health options before state,
national, and association language addressing such uses were yet
created (prior to 2012). LaRose has been a National
Association of Social Workers Florida State Lead Presenter on the
topic of digital mental health services in 2016.
Additionally LaRose is heavily involved in consulting other
online platforms in expanding the technology to other providers
and other services (such as peer to peer online consults for
licensing and situational collaborative
interventions).
Clients using digi-mental health are generally aware (less and
less so given streamlining that resulted during the 2020-2021
pandemic) that digital services, particularly mental health,
continues to be considered a non-traditional service. As
such, journaling, emailing, file sharing, even in the end to end
encryption platform remains on the cutting edge of social
services technology. To date, the server has not been
hacked; however the DOD, the IRS, BCBS, the DNC and other
organizations of paramount security expertise have been. It
is imperative for users to know that the risk of such a hacking
occurrence is expressly noted and acknowledged. If such a
"hack" were to occur the law requires that users be
notified. HIPAA laws and rules govern the
access of private health information and licensing standards
govern the disclosure of peer to peer consultative information,
when such events occur; this practice complies with the
notification, sentinel events recording of, and corrections
policies. The practice has not experienced hacking since
its implementation of the secure digital server in
2012. The services with LaRose, as they are stored and
recorded, used and accessed in the server are all HIPAA compliant
in security (not all platforms for video, chat, are HIPAA
compliant).
Use of Government and Business Email Accounts and Sharing of
Server Usernames and Passwords. Clients agree NOT TO
DISCLOSE or SHARE THEIR SERVER USERNAME AND PASSWORD WITH ANY
OTHER PARTY. Clients agree to use their personal email
address for communications with the practice of LaRose and in
registering for services with the practice (clients should not
use government email addresses and unless self-employed and
controlling your own email account, clients should not use
company based email addresses when registering and working with
the practice).
Safety. Persons who are aware that safety is a relevant
consideration in their mental health history (past or present)
are encouraged to contact a mental health professional via
telephone, rather than via online methods. Where safety concerns
are compelling, users should contact 911 (24 hours a day), text
741-741 (or see the https://talkifuwant.com/911 page). Safety
threats via online communications may require quicker response
times (particularly in cases where clients disconnect without
consensus) to ensure client and other well being. Matters
of safety such as child and elder abuse, actual and imminent
threats of harm, suicide and homicide risks are all assessed
when/if these are reported by clients or suspected by
LaRose. Confidentiality standards, that is the release of
protected health information and mental health records laws, are
superseded by safety laws and standards of care. That is to
say, clients are advised and agree they are aware that in matters
of safety risk determinations these matters are of a mandated
reporting standard, and as such are reported to the appropriate
regulatory and enforcement body. While mandated reporting
is often confidential from those who make such reports, it is
USUALLY (not always) the practice of LaRose to explain the
reporting and to assist clients in dealing with services that are
provided outside the scope of the practice; mandated reports are
not handled by the practice (only reported when the scenario is
evident and/or reasonably suspected by the practice), as such the
interventions and legal steps taken by the receiving party of the
mandated report is handled and resolved between the client and
the agency who handles such reports. It is common
during the course of mandated reporting for other information to
be disclosed to the receiving agency - over and above the harm or
risk of harm, such as diagnosis information, disability
information, concerns about weapons, location of the client,
etc. It is also common for follow-up communications to
occur between the receiving agency and the practice. The
exception to confidentiality is explained here to inform clients
of other ways health and session related information could be
shared, when/if safety risks are evident.
Confidentiality and Release of Records. Mental health
providers cannot acknowledge or deny knowing a client under any
circumstances (outside of safety) without a written specific
consent that explains what information is being shared, why it is
being requested, if it is denied by the client what impact such
denial may have on care, and how long the release is
permitted. Mental health providers cannot talk to family
members, friends, or other providers about a client without
written consent. Likewise the practice of LaRose cannot
obtain other provider information about a client, without written
consent. If another provider, based on client consent,
releases information to LaRose, those 'other provider' records
are scanned into the client digital file, after review, and the
client is notified of such receipt and review in the secure
server. Those records can be discussed. Providers
cannot forward the records of another provider, even with client
consent, and even if those records are scanned into the
server. Each provider must generate their own records and
clients wishing for all records to be forwarded to a certain
provider would need to sign a HIPAA compliant release for each
provider to do so. In the case of court orders, or
subpoenas, the practice of LaRose must respond to properly served
subpoenas and will do so. Even with subpoenas clients are
notified of the subpoena and they are asked if they would like to
review the records that are court ordered, prior to a release
(even if the subpoena is from the clients own attorney).
Clients have a right to review their records and they have a
right to request that any errors be corrected; in the case where
a client disagrees with the record (that is it is not factually
or clinically in error) the client has a right to include a
statement of their disagreement into their medical records, and
the practice of LaRose will include such disagreements in the
record to reflect the client notice. Notification of a
correction/error/disagreement can be made in the secure server,
at the time it is realized, and LaRose will respond to the notice
within a 14 day period (often within a day or two, due to speed
of digital records storage, retrieval and generation). Some
records, those that are deemed to be the property of the
provider, not the client, can be withheld in released
records. Usually, when a records request occurs, the entire
file (excluding shared file attachments - as these are recorded
and explained in all session notes) is generated, including
treatment plans, progress notes, general notes, secure emails,
shared journals, and all legal consent documents.
Licensing. Florida, DC and Missouri licensing allows online
sessions with residents of the state; out of state online
requests, at least in the current evolution of social
communications technology, is not yet standardized and is not
permitted. Online clients will be asked to show a valid
government issued ID with their picture, DOB, and address on the
screen (and to upload an image of such in the secure server by
clicking the attachment options when prompted) at the time of or
prior to online services. This is done to ensure that
LaRose is NOT treating clients online, outside of the
jurisdictions where he is licensed. Residents of Florida,
Missouri and DC who are traveling out of the state, can continue
to be seen digitally, as long as they continue to be active
residents while travelling (an added plus to online
options). US wide services generally cannot be provided
(state licensing standards rule) online at this time as standards
of care and regulatory bodies remain behind the current trends in
social service digital mental health provisions of
services. All clients, regardless of residency, can be seen
in face to face sessions with LaRose in DC, FL and MO by
appointment only IF the office scheduling option is
available.
Malicious Breach. I (the client) agree that in the unlikely event
of a breach of confidentiality involving encrypted/secure online
communications occurs, it will be deemed a malicious and
intentional act by the office of LaRose and TalkifUwant.com and
the secure server linked to TalkifUwant.com (the secure client
area). Upon awareness or suspicion that such acts are occurring,
I understand that LaRose will contact the appropriate law
enforcement authorities while releasing all information necessary
to facilitate their investigation. I agree to cooperate fully
with any law enforcement agency investigating a malicious
confidentiality breach. I (the client) agree that I will
not attempt to breach any areas of the server during the course
of my care; I understand that at anytime I may be blocked if/when
suspicious behavior is recognized by the server.
Server and Practice Access. Clients agree that while they
have full 24 hour access to online service options in the
server, the server remains as the digital practice of
LaRose. As such, clients agree that LaRose, with or without
notice, may limit or block client access to services in the
server due to non-payment, verbal aggression that cannot be
regulated by interventions (as in repeated requests and problem
solving that does not cause verbal aggression to cease), misuse
of any of the online services, including excessive scheduling and
cancelling of appointments (as in taking more than the intended
number of sessions simply to hold a spot and then later
cancelling, excessively), or in the case of any other cause that
LaRose may explicate by secure email in the server.
ONLINE AND SOCIAL MEDIA PRESENCE, CLIENT REVIEWS AND DIGITAL
ETHICS DISCLOSURES. For more information on the developing
standards in online social services communication, users may want
to view ==>
http://www.naswdc.org/ldf/legal_issue/2007/200704.asp
It is important that clients (you) understand that the HIPAA
secure digital server as explained above and elsewhere is NOT THE
SAME THING AS DIGITAL SOCIAL MEDIA PLATFORMS (Skype is a social
media - non HIPAA secure platform; Facebook, Instagram, Twitter,
and the like are social media platforms). In November of
2017 the National Association of Social Workers advanced and
developed its social media and digital online policy statements
in its national code of ethics. The most recent governing
protocols for the practice of LaRose can be found at:
www.socialworkers.org (see code of ethics) and on the TalkifUwant
website their is a drop down to access practice policy statements
and uses in social media.
Clients using other digital platforms (social media), outside of
the practice secure server (which is NOT social media), relating
to the practice in any way, may run the risk of identifying
themselves as a patient/client. Users should use caution in
other non-secure platforms. LaRose maintains a large social
presence on Twitter, Facebook, Linkedin, Instagram (and a myriad
of other platforms). Users may access LaRose via other social
medial platforms ONLY IN THE PROFESSIONAL ONES USED BY LAROSE;
professionally practice related content is available using the
#TalkifUwant. Personal access is not permitted between
clients and LaRose thus any link requests where such is known to
be with a client and LaRose in a personal platform - will be
refused by LaRose at the personal level. Professional
contacts @talkifuwant are okay, however disclosures of self as a
client is NOT recommended. Client reviews of the services
by LaRose are encouraged (google reviews, healthgrades, yelp,
etc.), however clients are not required to do so and many can be
done confidentially.
Online reviews increasingly provide the tools by which providers
using online social services models found by others seeking
similar services. Please keep the practice in mind when/if
you make referrals, as you consider using these services, and
whether that by online reviews or direct person to person
suggestions is something you are comfortable with. Reviews
and referrals should be done anonymously; that is without
identifying yourself by name. LaRose cannot acknowledge or
deny seeing a person without written consent, thus if a referral
is made LaRose will not identify the referring party as a
patient/client.
Social Media Policy, Patient Bill of Rights and Privacy
Practices. You the client acknowledge that you have
reviewed and that you have been able to download and print from
the Talkifuwant.com website the following:
Social Media
Policy: https://talkifuwant.com/socialmedia
Patient Bill of
Rights: https://talkifuwant.com/patientbillofrights
Privacy Practices: https://talkifuwant.com/privacy-statement
This secure server is NOT social media. No other
party, besides LaRose and office personnel that may be needed to
effect your care/services (if they are involved at all), can
access your file in this secure HIPAA compliant platform.
Emailing, journaling and all records are encrypted, end to end
(from therapist to client and from client to therapist)
ONLY. Users of this platform cannot cross communicate or
access each others information as the server is a client by
client secure file within the online secure server of the
practice.
ONSITE SERVICES, ON LOCATION SERVICES, SUPERVISION, PROVIDER
DEVELOPMENT, CONCIERGE AND ANNUAL RETREAT SERVICES. The
practice of LaRose offers and provides various non-traditional
behavioral health, mental health, coaching, hypnosis,
consultation and retreat type services, in addition to the online
video/chat/journaling sessions and may at some times offer
traditional face to face options (face to face options are not
currently available). These expanded services allow for remote
counseling program implementation, remote supervision and
licensee consultation, in and out of state therapy/education
based retreats and get aways, provider practice set up services
each unique and customized to the needs and demands of clients,
peers, supervisees and institutional based services.
This agreement provides for an overview of the practice involving
billing, records, the use of the digital server and general
cancellation matters. Specific terms are provided
subsequent to this initial consent and server portal set up
process, related to the specific requests of the user, as fitting
and appropriate to your situation. It is disclosed here, that in
addition to these terms, other contract terms may be added later,
to accommodate the specific and unique requests of other parties
involving onsite services, hypnosis and coaching services,
retreat services, supervision services and provider set up
services. If and when your situation requires an addendum
contract or an alternative contract subsequent to this portal
registration, this will be discussed in your initial
consult.
Upon registering and logging in you will choose what service you
are seeking from the practice (and you can choose multiple
services) which will be reviewed and discussed during the initial
consultation. If there are questions due to data entry
errors, confusing answers or possible changes that have not been
globally updated in the digital platform, after you register
here, LaRose may call or text prior to your services being
initiated. LaRose may elect to cancel scheduled services
until the confusion is resolved (if one is realized during the
online "onboarding" process) that is currently underway.
===>
ANNUAL RENEWAL FOR BILLING PRACTICES, HIPAA, AND POLICY UPDATES
AUTHORIZED BY USERS. This authorization will be renewed annually
via annual forms that are required upon server log ins the first
month of every calendar year and/or as changes may be
needed/required. This summary will be incorporated into the new
year policy changes and updates, where clients must provide new
authorizations for billing, updated contact and emergency contact
information, and annual renewals of privacy statement updated
regarding protected health information. These updates mean that
new clients may be required to complete an initial authorization,
and an "updated one" due to automation limitations. Clients
agree that this and any other subsequent authorization and
information regarding protected health information is available
to be printed out in the server, at the time it is completed,
and/or the client acknowledges that a copy of such documents can
be requested and printed out in the server. Each years
forms, as updated, are incorporated herein - thus this document
and the updated yearly renewal forms reciprocally reference each
other (necessary for ongoing authorizations). Example: this form
is the initial required agreement between you and the practice
for all services, however, every year various rules, laws,
contract terms, and standards of care/practice require renewed
authorizations (both forms are active from year to year, as these
occur). Any revisions to billing practices, collections, health
information standards etc. etc. are referenced in the newest
renewal forms that clients will be required to complete each
year, after logging in. Each form as it is updated,
includes an update chronology sequence on the form
itself.
Questions?
CL & TXT: 850.545.2886
EM: Kurt@TalkifUwant.com (non secure emails are not replied to
here; use of the secure email platform is recommended)
WB: www.TalkifUwant.com
| LicensedClinical Social Worker | Credentialed in Clinical
Hypnosis | CSW Qualified Supervisor | Licensed Independent
Clinical Social Worker |
Florida License: SW9297
Washington DC License: LC50081569
Missouri License: 2020023042
Initial Online Information & Consent Revision History: 02/2012,
12/30/2012, 10/16/2014, 06/15/2015, 6/26/2017, 11/02/2017,
12/12/17; 4/13/18; 4/26/18; 7/11/18; 2/10/21; 10/28/21
