List of Figures, Forms, Handouts, and Tables |
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xxi | |
Introduction |
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1 | (7) |
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Ways This Book Can Help You |
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1 | (1) |
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2 | (1) |
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3 | (1) |
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How to Use This Book in Your Practice |
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4 | (1) |
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Quick Start: Recommended Core Materials |
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4 | (1) |
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Availability of Materials on CD |
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5 | (1) |
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A Cautionary Note and Disclaimer |
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5 | (1) |
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About Reproducing Materials in This Book |
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6 | (1) |
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7 | (1) |
1 Essential Documents, Procedures, and Communication Tools |
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8 | (35) |
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1.1 Basic Practice Management Documents and Communication Tools: An Overview |
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8 | (1) |
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9 | (7) |
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Ethical Aspects of Self-Presentation |
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9 | (1) |
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Guidelines for Clear and Accurate Self-Presentations |
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9 | (2) |
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The Name of Your Practice |
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11 | (1) |
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Your Letterhead and Cards |
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12 | (3) |
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Your Resume and Curriculum Vitae |
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15 | (1) |
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1.3 Your Appointment Book |
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16 | (3) |
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Figure 1.1. Sample curriculum vitae, partially filled in |
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17 | (1) |
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What an Appointment Book Should Include |
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18 | (1) |
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A List of Current Clients |
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18 | (1) |
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Pros and Cons of Paper versus Electronic Appointment Books |
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18 | (1) |
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1.4 Basics of Record Keeping |
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19 | (7) |
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19 | (1) |
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What Should Be in the Records? |
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20 | (2) |
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Pros and Cons of Paper versus Electronic Records |
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22 | (2) |
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The Physical Structure for Organizing Paper Records |
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24 | (2) |
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Form 1.1. Checklist for client records |
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25 | (1) |
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26 | (9) |
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27 | (2) |
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Steps for Becoming HIPAA-Compliant |
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29 | (4) |
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Form 1.2. Checklist of security procedures for a small psychotherapy practice |
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30 | (3) |
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33 | (2) |
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35 | (2) |
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How Long Should Records Be Kept? |
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35 | (1) |
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Suggestions about Retaining Records |
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36 | (1) |
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Disposing of Your Records |
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36 | (1) |
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1.7 When You Close Your Practice, Retire, or Die: Preserving Your Records with a Professional Will |
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37 | (6) |
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38 | (3) |
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If You Should Suddenly Become Incapacitated or Die |
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41 | (2) |
2 Financial Tools and Procedures |
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43 | (18) |
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2.1 Setting Financial Policies for Your Practice |
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43 | (8) |
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44 | (1) |
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Ethical Guidelines on Fees |
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44 | (1) |
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45 | (2) |
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47 | (2) |
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Arranging and Discussing Fees with Clients |
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49 | (2) |
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2.2 The Income and Expense Records |
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51 | (2) |
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52 | (1) |
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Choosing a Business Credit Card |
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52 | (1) |
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The Monthly/Quarterly Expense Summary |
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52 | (1) |
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2.3 Methods of Billing for Payment |
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53 | (4) |
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Accepting Credit Cards or Smartphone Services |
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53 | (1) |
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54 | (1) |
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54 | (1) |
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54 | (1) |
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Completing the CMS-1500 Standard Billing Form |
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55 | (1) |
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Billing Services and Clearinghouses |
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56 | (1) |
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Computerized Billing Programs |
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56 | (1) |
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56 | (1) |
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2.4 Collecting Overdue Fees from Clients |
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57 | (4) |
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58 | (1) |
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Sending a Note on the Bill |
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58 | (1) |
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Sending Collection Letters |
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58 | (1) |
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58 | (1) |
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Avoiding Illegal and Unethical Billing Procedures |
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59 | (1) |
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59 | (2) |
3 Health Insurance and Managed Mental Health Care: Billing Third Parties and Getting Paid |
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61 | (39) |
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3.1 The Health Care Landscape |
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61 | (1) |
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3.2 To Take Insurance or Not? |
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62 | (2) |
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62 | (1) |
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63 | (1) |
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63 | (1) |
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3.3 Getting NPI Number(s) |
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64 | (1) |
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3.4 Which Insurance Company Panels Should I Consider Joining? |
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64 | (3) |
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The National and Local Reach of a Company |
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65 | (1) |
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The Structure of the Company |
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65 | (1) |
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The Level of Independence versus Oversight |
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66 | (1) |
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66 | (1) |
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66 | (1) |
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The Reputation of the Company among Your Peers |
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67 | (1) |
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3.5 Applying to Insurance Companies to Become a Provider |
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67 | (7) |
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67 | (1) |
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Your Contract with the Insurer or MCO |
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68 | (3) |
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The Special Case of Enrolling with Medicare |
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71 | (2) |
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73 | (1) |
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3.6 Beginning to See MCO Clients |
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74 | (11) |
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Verifying Coverage, Eligibility, and Benefits |
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74 | (4) |
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Form 3.1. Behavioral health insurance benefits questionnaire |
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75 | (3) |
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78 | (2) |
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Initial Discussions with the Client about MCO-Related Ethical Issues |
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80 | (2) |
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A Client Education Handout about Managed Care |
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82 | (3) |
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Handout 3.1. Client handout for education about/informed consent to managed care |
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83 | (2) |
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3.7 Submitting Claims to Get Paid |
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85 | (9) |
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Ethical and Legal Considerations in Billing Insurers or MCOs |
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85 | (1) |
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What You Need to Know for Insurance Claim Processing |
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86 | (2) |
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The Concept of "Medically Necessary" Care |
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88 | (2) |
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Form 3.2. Medical-necessity-for-psychotherapy checklist |
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89 | (1) |
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90 | (1) |
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Making the Claim on the CMS-1500 |
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91 | (1) |
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How to Submit Claims Electronically |
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91 | (1) |
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When Should You Hire a Biller? |
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92 | (1) |
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Checklist for Evaluating a Potential Billing Service |
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92 | (2) |
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3.8 Billing for Medicare Clients |
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94 | (1) |
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Providing Noncovered Services to Medicare Beneficiaries |
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94 | (1) |
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How to Opt Out of Medicare and See Medicare-Covered Clients as Private Pay Clients |
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94 | (1) |
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3.9 Tips for Dealing with Managed Care |
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95 | (3) |
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Late Payments from Insurers |
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95 | (1) |
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Continuity-of-Care Concerns |
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95 | (1) |
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Dealing with MCO Reviewers |
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96 | (2) |
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3.10 The Future of Insurance in Mental Health Care |
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98 | (2) |
4 Reducing Malpractice Risk by Operating Ethically |
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100 | (75) |
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4.1 Ethics and Malpractice |
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100 | (6) |
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Why Are Ethical and Legal Issues So Complicated? |
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100 | (1) |
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The Formula for Risk and Risk Management |
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101 | (1) |
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The Licensing Board Risks for Clinicians |
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101 | (2) |
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Figure 4.1. The formula for risk and risk management |
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101 | (1) |
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Table 4.1. Most Common Types of Disciplinary Actions by APA Ethics Committee, 1994-2003: Cases with Multiple Categories |
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102 | (1) |
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The Major Malpractice Risks for Clinicians |
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103 | (1) |
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Table 4.2. Major Causes of Successful Malpractice Suits against Psychologists |
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103 | (1) |
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Four Steps toward Ethical Self-Protection |
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104 | (2) |
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4.2 Legal Aspects of Malpractice |
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106 | (6) |
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106 | (1) |
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106 | (1) |
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The Good News (for Us): The Real Risks Are Small |
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107 | (1) |
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The Bad News (for Us): Malpractice Accusations Hurt |
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108 | (1) |
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Where to Get Advice on Legal/Ethical Problems |
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108 | (1) |
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What to Do If You Are Complained Against: A Checklist |
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109 | (3) |
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4.3 Professional Liability ("Malpractice") Insurance |
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112 | (10) |
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113 | (1) |
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Occurrence-Based versus Claims-Made Policies |
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113 | (2) |
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Figure 4.2. An illustration of your coverage in claims-made and occurrence-based policies over time |
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114 | (1) |
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Points of Comparison and Advantage |
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115 | (1) |
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Guidelines and Issues to Consider When Purchasing Liability Insurance |
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116 | (6) |
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Other Kinds of Insurance to Consider |
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122 | (1) |
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4.4 Ways to Reduce Your Risk of Malpractice |
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122 | (9) |
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Twenty-Four Steps for Risk Reduction |
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123 | (6) |
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Sensitivity to Differences in Culture, Religion, Gender, and Other Dimensions of Diversity |
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129 | (2) |
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131 | (7) |
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Figure 4.3. Gutheil and Gabbard's model of crossed role boundaries |
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132 | (1) |
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Why Avoid Dual (or Multiple) Relationships? |
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133 | (3) |
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Figure 4.4. Are you in trouble with a client? |
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134 | (2) |
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Examples of Multiple Relationships |
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136 | (1) |
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When Dual Relationships Are Unavoidable: Weighing Their Effects |
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137 | (1) |
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Preventing Boundary Crossings and Violations |
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138 | (1) |
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4.6 Sexual Intimacies in Therapy |
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138 | (10) |
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What Is Meant by "Sexual Intimacies"? |
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138 | (2) |
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Handout 4.1. Client handout on limits of the therapy relationship |
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139 | (1) |
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With Whom Are Sexual Intimacies Prohibited? |
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140 | (1) |
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The Damage to the Client and to Therapy |
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140 | (1) |
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Is Sexual Intimacy with a Client Ever Acceptable? |
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141 | (1) |
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A Checklist of Preventative Measures |
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142 | (1) |
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What to Do If a Client Asks You for Sex |
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143 | (1) |
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What to Do If You Are Attracted to a Client |
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143 | (1) |
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Reporting Another Therapist |
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144 | (1) |
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Client-Therapist Intimacy: Appropriate and Inappropriate Conduct |
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144 | (4) |
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Handout 4.2. Client handout on client-therapist contact |
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145 | (3) |
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4.7 Assessing a Client's Dangerousness to Self and Others |
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148 | (12) |
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149 | (1) |
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Gathering Information to Assess Risk |
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149 | (1) |
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The Issues and Risk Factors of Suicide |
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149 | (1) |
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Assessing Suicide Potential: Risk Factor Analysis versus Predictions of Suicide |
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150 | (5) |
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Form 4.1. Checklist of suicide risk factors |
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151 | (4) |
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Responding to a Suicidal Crisis |
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155 | (1) |
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The Risk Factors for Interpersonal Violence |
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156 | (1) |
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Analyzing the Information Gathered |
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157 | (1) |
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Documenting the Situation and Your Actions |
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158 | (1) |
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158 | (2) |
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160 | (1) |
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4.8 The Duty to Protect (and Warn) |
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160 | (5) |
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161 | (1) |
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When Do You Have a "Duty to Warn"? |
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161 | (1) |
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What to Do When You Decide to "Warn" |
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162 | (1) |
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162 | (1) |
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Domestic Violence and Abuse |
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163 | (1) |
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Limiting Your Personal Vulnerability to Violence |
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164 | (1) |
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4.9 Legal and Ethical Aspects of Supervising and Being Supervised |
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165 | (10) |
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165 | (2) |
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167 | (5) |
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Form 4.2. Agreement for professional supervision |
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168 | (4) |
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A Record of Supervision Meetings |
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172 | (2) |
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174 | (1) |
5 Getting Informed Consent |
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175 | (77) |
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5.1 The What and Why of Getting Informed Consent |
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175 | (6) |
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What Is Informed Consent? |
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175 | (1) |
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What Informed Consent Requires |
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176 | (4) |
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Informed Consent in Three Steps |
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180 | (1) |
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The Five Paths to Informed Consent |
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181 | (1) |
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5.2 The First Path to Informed Consent: The Client Information Brochure |
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181 | (35) |
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181 | (1) |
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Table 5.1. Types and Purposes of Brochures Used in Psychotherapy |
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182 | (1) |
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How to Use the Model Client Information Brochure |
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182 | (1) |
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The Model Client Information Brochure |
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183 | (33) |
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5.3 The Second Path to Informed Consent: The Question List as a Guide to Discussion |
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216 | (8) |
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Handout 5.1. Question list for therapist-client discussion (client's version) |
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222 | (2) |
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5.4 The Third Path to Informed Consent: Lists of Clients' Rights |
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224 | (1) |
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5.5 The Fourth Path to Informed Consent: Psychotherapy Contracts |
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224 | (15) |
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225 | (1) |
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Checklists for Psychotherapy Contracts: Elements and Options |
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225 | (2) |
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A Contract for Individual Therapy with an Adult |
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227 | (1) |
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Contracts for Couples and Families |
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227 | (3) |
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Form 5.1. Contract for individual adult therapy |
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228 | (2) |
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Contracts for Therapy with Minors |
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230 | (3) |
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Form 5.2. Contract with parent/guardian for psychotherapy with a minor |
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232 | (1) |
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A Contract for Group Therapy |
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233 | (6) |
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Form 5.3. Contract for psychotherapy with an older child or adolescent |
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234 | (3) |
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Form 5.4. Contract for group therapy |
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237 | (2) |
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5.6 The Fifth Path to Informed Consent: Consent to Treatment and Other Services |
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239 | (7) |
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Generic Consent to an Adult's Treatment |
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240 | (1) |
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Generic Consent to a Minor Child's Treatment |
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240 | (1) |
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Consent to Counseling for a Child of Separation or Divorce |
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240 | (6) |
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Form 5.5. Form for generic consent to treatment of an adult |
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241 | (1) |
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Form 5.6. Form for generic consent to treatment of a child |
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242 | (2) |
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Form 5.7. Agreement for parents regarding limitations and goals of psychotherapy with a child of separation or divorce |
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244 | (2) |
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246 | (6) |
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Authorization to Record Sessions and Use Case Materials |
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246 | (1) |
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Consent to Psychological Testing and Assessment |
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247 | (3) |
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Form 5.8. Release/permission form for recording sessions and using case materials in research, teaching, and professional publishing |
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248 | (2) |
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Consent to Being Evaluated for a Third Party |
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250 | (2) |
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Form 5.9. Consent form and contract for psychological testing and evaluation |
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251 | (1) |
6 Intake and Assessment Forms and Procedures |
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252 | (85) |
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6.1 Creating the Client's Chart |
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252 | (1) |
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The Chronology of Record Making |
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252 | (1) |
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The Contents of the Record |
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253 | (1) |
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6.2 Phase 1: The Initial Telephone Contact |
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253 | (7) |
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Reasons for Refusing a Caller as a Client |
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254 | (1) |
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Getting the Essential Data |
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255 | (5) |
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Form 6.1. First-contact record |
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256 | (4) |
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6.3 Phase 2: The New-Client Package and Other Preappointment Contacts |
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260 | (4) |
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Ways to Respond Before the Initial Appointment |
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260 | (1) |
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Ways of Dealing with No-Shows |
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261 | (2) |
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Form 6.2. Letter of appointment confirmation |
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262 | (1) |
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263 | (1) |
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6.4 Phase 3: The New Client's Arrival for a First Meeting |
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264 | (44) |
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The Notice of Privacy Practices and the Related Consent Form |
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264 | (14) |
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Form 6.3. Notice of privacy practices (unabridged) |
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267 | (9) |
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Form 6.4. Notice of privacy practices (brief version) |
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276 | (1) |
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Form 6.5. Consent to privacy practices |
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277 | (1) |
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Ways of Collecting Further Client Information |
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278 | (1) |
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Obtaining the Client's Demographic Information |
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279 | (6) |
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Form 6.6. Adult client demographic information form |
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280 | (5) |
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Obtaining the Client's Clinical Information |
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285 | (4) |
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Form 6.7. Adult client clinical information form |
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286 | (3) |
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Obtaining the Client's Medical Information |
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289 | (5) |
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Form 6.8. Health information form |
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291 | (3) |
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294 | (4) |
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Form 6.9. Chemical use survey |
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295 | (3) |
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Obtaining Financial Information |
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298 | (1) |
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Assuring Financial Responsibility |
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298 | (4) |
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Form 6.10. Financial information form |
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299 | (2) |
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Form 6.11. Agreement to pay for professional services |
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301 | (1) |
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302 | (1) |
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Obtaining Information on Child Clients |
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303 | (5) |
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Form 6.12. Adult checklist of concerns |
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304 | (2) |
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Form 6.13. Child checklist of characteristics |
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306 | (2) |
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6.5 Phase 4: First Meeting with a New Client |
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308 | (14) |
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Form 6.14. Child information form |
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309 | (7) |
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Preparing the Client for the Intake Interview |
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316 | (1) |
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Using the Intake Interview Questions and Guide |
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316 | (3) |
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Form 6.15. Intake interview questions and guide |
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317 | (2) |
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Collecting Information from Young Adults |
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319 | (1) |
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Special Considerations for Interviewing a Child |
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319 | (3) |
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Form 6.16. Information form for young adults |
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320 | (2) |
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The Evaluation of Mental Status |
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322 | (1) |
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6.6 Phase 5: Summarizing the Intake Information |
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322 | (15) |
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Summarizing Chemical Use and Suicide Risk Data |
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322 | (1) |
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Formulating the Whole Case |
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322 | (15) |
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Form 6.17. Mental status evaluation checklist |
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323 | (3) |
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Form 6.18. Chemical user's case formulation |
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326 | (3) |
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Form 6.19. Suicide risk assessment summary and recommendations |
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329 | (3) |
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Form 6.20. Intake summary and case formulation |
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332 | (5) |
7 Planning and Then Documenting Treatment |
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337 | (46) |
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337 | (5) |
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337 | (1) |
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Guidelines for Treatment Planning |
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338 | (1) |
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Systems and Formats of Treatment Planning |
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339 | (1) |
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Other Points in Planning Treatment |
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340 | (1) |
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Formulating Treatment Plans for Managed Care Organizations |
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341 | (1) |
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7.2 Documenting Treatment's Progress |
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342 | (23) |
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Note Taking: Guidelines and Suggestions |
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342 | (7) |
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Two Kinds of Clinical Notes: Routine Progress Notes and Psychotherapy Notes |
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349 | (1) |
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A Comparison of Routine Progress Notes and Psychotherapy Notes |
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350 | (3) |
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Deciding Whether to Keep Psychotherapy Notes |
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353 | (1) |
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Format for a Psychotherapy Note |
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354 | (1) |
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A Basic Format for Routine Progress Notes |
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355 | (4) |
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Form 7.1. HIPAA-based case progress note |
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356 | (1) |
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Form 7.2. Case progress note, structured |
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357 | (2) |
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The Problem-Oriented Record |
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359 | (4) |
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Figure 7.1. Column headings for a problem-oriented record (POR) problem list |
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360 | (2) |
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Figure 7.2. Completed example of a POR progress note form |
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362 | (1) |
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A Structured Form for Group Therapy |
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363 | (1) |
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Client-Generated and Co-Created Records |
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363 | (2) |
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Form 7.3. Structured progress note form for group therapy |
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364 | (1) |
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Progress Assessment Measures |
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365 | (1) |
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Evaluating Each Therapy Session |
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365 | (1) |
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365 | (8) |
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Form 7.4. Session evaluation questionnaire |
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366 | (1) |
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Reasons for Terminating or Transferring a Client |
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367 | (1) |
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How to Terminate Treatment in Different Situations |
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|
368 | (5) |
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7.4 The Case Closing Summary |
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|
373 | (1) |
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Outline for Dictating a Case Closing Summary |
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|
373 | (1) |
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A Termination Summary Form |
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|
374 | (1) |
|
7.5 Assessing Client Satisfaction and Outcomes |
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374 | (9) |
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Client Satisfaction Measures |
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|
374 | (3) |
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Form 7.5. Termination summary form |
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|
375 | (2) |
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Outcome Assessment Questionnaires |
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|
377 | (6) |
|
Form 7.6. Client satisfaction follow-up questionnaire |
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|
378 | (3) |
|
Form 7.7. Client outcome follow-up questionnaire |
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|
381 | (2) |
8 Confidentiality and Releasing Records |
|
383 | (58) |
|
8.1 Understanding Confidentiality |
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383 | (16) |
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|
383 | (2) |
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Common Exceptions to Confidentiality |
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|
385 | (5) |
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Other Points about Confidentiality and Its Limitations |
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|
390 | (1) |
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Confidentiality and Children |
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|
391 | (1) |
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Confidentiality and HIV-Positive Clients |
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|
392 | (1) |
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An Electronic Communications Policy for Your Practice |
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|
392 | (2) |
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A Handout on the Limits of Confidentiality |
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|
394 | (5) |
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Handout 8.1. Client handout on limits of the therapy relationship |
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|
396 | (3) |
|
8.2 Maintaining Confidentiality |
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|
399 | (7) |
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Guidelines for Maintaining Confidentiality |
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|
399 | (3) |
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Training Employees in Privacy Practices |
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|
402 | (1) |
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A Checklist for Staff Training in Confidentiality |
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402 | (3) |
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Form 8.1. Checklist for staff training in confidentiality |
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|
403 | (2) |
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Creating Confidential Records |
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|
405 | (1) |
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|
405 | (1) |
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8.3 Releasing Clients' Records |
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|
406 | (16) |
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|
406 | (1) |
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Ethical Considerations in Releasing Records |
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|
407 | (1) |
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Legal Requirements for a Release of Information |
|
|
408 | (1) |
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Eight Variations on the Theme of "Please Send Your Records" |
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|
409 | (11) |
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Table 8.1. Coping with a Subpoena for Client Records |
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|
416 | (4) |
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Guidelines and Considerations in Sending Records |
|
|
420 | (1) |
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|
421 | (1) |
|
8.4 Forms for Requesting and Releasing Information |
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|
422 | (5) |
|
A Comprehensive Request/Release Form |
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|
422 | (5) |
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Form 8.2. Form for requesting or releasing confidential records and information |
|
|
423 | (4) |
|
A Briefer Request/Release Form |
|
|
427 | (1) |
|
8.5 More Specific Releases of Information |
|
|
427 | (4) |
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Releasing Information to an Attorney |
|
|
427 | (3) |
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Form 8.3. Briefer form for requesting or releasing confidential records and information |
|
|
428 | (2) |
|
Releasing Information to the Client's Family |
|
|
430 | (1) |
|
A Release-of-Records Cover Letter |
|
|
431 | (1) |
|
8.6 Confidentiality When Faxing Records or Sending Email |
|
|
431 | (5) |
|
Form 8.4. Authorization to release confidential information to family members |
|
|
432 | (2) |
|
Form 8.5. A release-of-records form letter |
|
|
434 | (2) |
|
8.7 Confidentiality Notifications |
|
|
436 | (1) |
|
8.8 Business Associates and Privacy |
|
|
437 | (1) |
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|
438 | (3) |
|
Unauthorized Disclosures and Breaches |
|
|
438 | (1) |
|
Complaints and Reports of Privacy Violations |
|
|
438 | (1) |
|
|
439 | (1) |
|
|
439 | (2) |
|
Form 8.6. A sample complaint form |
|
|
440 | (1) |
9 Marketing Your Practice in the Digital Age |
|
441 | (24) |
|
9.1 Marketing Your Practice Ethically |
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|
441 | (2) |
|
Ethics and Traditional Marketing |
|
|
441 | (1) |
|
Digital Ethics: Things That Seem Like Good Ideas but Aren't |
|
|
442 | (1) |
|
9.2 Traditional Forms of Marketing |
|
|
443 | (7) |
|
Talking about What You Love as a Marketing Method |
|
|
443 | (1) |
|
Looking for Potential Referrers |
|
|
444 | (1) |
|
A Letter for Seeking Referrals from Physicians and Other Medical Staff |
|
|
444 | (2) |
|
Seeking Referrals for Group Therapy |
|
|
446 | (1) |
|
"Thanks for the Referral" Notes |
|
|
447 | (1) |
|
|
448 | (1) |
|
|
448 | (1) |
|
|
449 | (1) |
|
Patient Education Handouts as Practice Marketing |
|
|
450 | (1) |
|
9.3 Tracking Your Referral Sources |
|
|
450 | (2) |
|
Figure 9.1. Characteristics of new clients |
|
|
451 | (1) |
|
9.4 Collecting Feedback on Your Psychological Reports |
|
|
452 | (1) |
|
9.5 Online Marketing, or "Hanging Out Your Shingle in Cyberspace" |
|
|
453 | (6) |
|
Online Directories of Therapists |
|
|
453 | (1) |
|
|
454 | (1) |
|
|
454 | (1) |
|
|
455 | (3) |
|
|
458 | (1) |
|
Search Engine Optimization |
|
|
458 | (1) |
|
9.6 Social Media and Online Networking |
|
|
459 | (1) |
|
9.7 Do I Need a Social Media Policy, and If So, What Should Be in It? |
|
|
460 | (2) |
|
Should You Search for Your Clients on Google or Social Media? |
|
|
461 | (1) |
|
|
461 | (1) |
|
|
462 | (1) |
|
|
463 | (2) |
Appendices: Resources |
|
465 | (6) |
|
Appendix A. Resources for Closing a Practice and Making a Professional Will |
|
|
465 | (2) |
|
Appendix B. Professional Liability Insurance Resources |
|
|
467 | (1) |
|
|
467 | (1) |
|
|
467 | (1) |
|
Appendix C. Books on Practice Development and Marketing |
|
|
468 | (3) |
References |
|
471 | (16) |
Index |
|
487 | (14) |
Feedback Form |
|
501 | (1) |
Instructions for Installing The Paper Office for the Digital Age's Forms on Your Computer |
|
502 | |