KENTE THERAPY SPACE is hosted on the Wix.com platform. Wix.com provides us with the online platform that allows us to present our products and services to you. Your data may be stored through Wix.com’s data storage, databases and the general Wix.com applications. They store your data on secure servers behind a firewall.
All direct payment gateways offered by Wix.com and used by our company adhere to the standards set by PCI-DSS as managed by the PCI Security Standards Council, which is a joint effort of brands like Visa, MasterCard, American Express and Discover. PCI-DSS requirements help ensure the secure handling of credit card information by our store and its service providers. Payment through Kareo is via Stripe, and a separate form will be emailed to you.
KENTE THERAPY SPACE may contact you to notify you regarding your account, to troubleshoot problems with your account, to resolve a dispute, to collect fees or monies owed, to poll your opinions through surveys or questionnaires, to send updates about our company, or as otherwise necessary to contact you to enforce our User Agreement, applicable national laws, and any agreement we may have with you. For these purposes we may contact you via email, telephone, text messages, and postal mail.
If you don’t want us to process your data anymore, please contact us at firstname.lastname@example.org or send us mail to: Kente Therapy Space LCSW PLLC
73 Market Street, Suite 376, Yonkers, New York 10710
As a health care provider I provide telehealth consultation. This is an explanation of how the video conferencing technology will be used to affect such a consultation. It will not be the same as a direct client/health care provider visit due to the fact you will be in another location and will not be in the same room as your provider. A telehealth consultation has potential benefits including easier access to care and the convenience of meeting from a location of your choosing in the state you reside in.However, there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.
As a healthcare provider or client you can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.
We can have a direct conversation to ask questions in regard to this procedure.
You are able to have all questions answered and the risks, benefits and any practical alternatives discussed.
CONSENT TO USE THE TELEHEALTH BY KENTE THERAPY SPACE
Telehealth is the technology used to conduct video conferencing appointments. It is simple to use.
You will be asked to sign an agreement. This document is to acknowledge use of the technology:
KENTE THERAPY SPACE is NOT an Emergency Service and in the event of an emergency and/or crisis situation I will use a phone to call 911. Though my services are provided to you directly, through virtual telehealth service, neither KENTE THERAPY SPACE nor clinician provides any emergency medical or healthcare outside of the scope of psychotherapy.
Notice of Psychotherapist’s Policies and Practices to Protect the Privacy of Your Health Information THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Your counselor may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:“PHI” refers to information in your health record that could identify you.“Treatment, Payment, and Health Care Operations” -Treatment is when your counselor provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when your counselor consults with another health care provider, such as your family physician or another psychotherapist.
-Payment is when you obtain reimbursement for your healthcare. Examples are if your counselor discloses your PHI to your health insurer for reimbursement for health care.
-Health Care Operations are activities that relate to the performance and operation of your counselor’s practice. Examples of healthcare operations are quality assessment and improvement activities, business related matters such as audits, administrative services, case management, and care coordination. “Use” applies only to activities within your counselor’s [office, clinic, practice group, etc.] such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.“Disclosure” applies to activities outside of your counselor’s [office, clinic, practice group, etc.] such as releasing, transferring, or providing access to information about you to other parties
II. Uses and Disclosures Requiring Authorization
Your counselor may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your counselor is asked for information for purposes outside of treatment, payment or health care operations, your counselor will obtain an authorization from you before releasing this information.
You may revoke all such authorizations (of PHI Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) your counselor has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
Your counselor may use or disclose PHI without your consent or authorization in the following circumstances: CHILD ABUSE – If your counselor has reasonable cause to know or suspect that a child has been subjected to abuse or neglect, your counselor must immediately report this to the appropriate authorities.
ADULT AND DOMESTIC ABUSE – If your counselor has reasonable cause to believe that an at-risk adult has been mistreated, self neglected, or financially exploited and is at imminent risk of mistreatment, self-neglect, or financial exploitation, then your counselor must report this belief to the appropriate authorities.
JUDICIAL AND ADMINISTRATIVE PROCEEDINGS – If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof, such information is privileged under state law, and your counselor will not release information without your written authorization or a court order. The privilege does not apply when you are being evaluated or a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
SERIOUS THREAT TO HEALTH OR SAFETY – If you communicate to your counselor a serious threat of imminent physical violence against a specific person or persons, your counselor has a duty to notify any person or persons specifically threatened, as well as a duty to notify an appropriate law enforcement agency or by taking other appropriate action. If your counselor believes that you are at imminent risk of inflicting serious harm on yourself, your counselor may disclose information in order to initiate hospitalization.
WORKER’S COMPENSATION – Your counselor may disclose PHI as authorization by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
Your counselor is required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
Your counselor reserves the right to change the privacy policies and practices described in this notice. Unless your counselor notifies you of such changes, however, your counselor is required to abide by the terms currently in effect. If any policies and procedures are revised, your counselor will notify you by your preferred means.