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Informed Consent and Privacy Practices

CLIENT RIGHTS STATEMENT & INFORMED CONSENT

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You have chosen to receive services from EmployAbility: Employment and Housing Solutions (EmployAbility) and/or EmpowerAbility: Counseling and Psychoeducation (EmpowerAbility), a subsidiary of EmployAbility. Your choice to receive services is voluntary, and you may terminate services at any time.

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EmployAbility/EmpowerAbility reserves the right to terminate services at any time. Reasons for termination may include, but are not limited to, inappropriate behavior/conduct.

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Available services will be offered without discrimination and in accordance with all applicable laws and agency policies.

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Fee for Service

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There is a cost associated with both group and individual services. Payment is due before the start of any session.

 

If participating in a group, full payment for the entire series is due before attending any sessions. It is your responsibility to make an informed decision about your ability to attend a group before submitting payment. Space is limited, and your spot in the group is reserved for you upon receipt of payment. Early withdrawals or missed sessions are non-refundable.

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Fees for individual services are non-refundable unless appointments are cancelled at least 48 hours in advance.

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Comprehensive Community Services (CCS) and WI Division of Vocational Rehabilitation (DVR) clients are exempt from all fees.

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Virtual/Online Meetings

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​Video conference calling allows for improved accessibility. However, there are some factors that are important for you to understand. We make an effort to protect sensitive information, but there are inherent risks to conducting business using the internet, computers, and other technology, including unauthorized access. Disruptions of signals and problems with the internet’s infrastructure may cause broadcast and reception problems.

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​To maintain confidentiality, sharing your meeting link with anyone unauthorized to attend your session and any type of recording (video, audio, etc.) of sessions is strictly forbidden.

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​Unforeseen Circumstances

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Your provider will make every effort to be present and prepared for each session as it was originally scheduled. However, unforeseen circumstances such as internet disruption, issues with necessary technology/computer equipment, and illness may lead to the cancellation. Depending on the nature of the disruption, advance notice may or may not be possible. Someone will reach out to you when communication capabilities are restored.

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Records

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We keep electronic records for all clients. Records include identifying information and contact details, such as phone numbers and email addresses. We also make note of client engagement in sessions and keep records of what clients share during sessions. A professional assessment may also be included.

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Security breaches may result in unauthorized access to identifying or sensitive information. In the unlikely event of a security breach, you will be notified of the nature of the breach and what information may have been accessible to an unauthorized party.

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You may request a copy of your records, and you are responsible for any costs incurred. If you would like records to be sent to someone other than yourself, you must provide a Release of Information detailing your consent.

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Confidentiality

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You have the right to confidentiality under federal and state laws relating to the receipt of services.

 

There are some Limits to Confidentiality. All of our providers are mandated reporters and have a Duty to Warn and Protect:

 

​If you disclose a plan or threat to harm yourself, your provider must notify legal authorities. In addition, if you disclose a plan to harm another person, your provider is required to attempt to warn the possible victim and notify legal authorities.

 

Abuse of Children and Vulnerable Adults

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  • If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (i.e. the elderly, disabled), your provider must report this information to the appropriate state agency and/or legal authorities.

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Psychoeducation vs. Psychotherapy (If Applicable)

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Psychoeducational services are educational in design and purpose and are not therapeutic or a replacement for psychotherapy. In psychoeducational sessions, the provider will present evidence-based material that has been found to be useful for people wishing to address concerns related to the session topic. Time is allowed for discussion, and opportunities for you to share how concepts relate to your personal life. If issues arise that are not suitable for this educational experience, you may benefit from individual psychotherapy.

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Risks of Psychoeducation, Psychotherapy, and Other Mental Health and Vocational Services

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Psychoeducation, psychotherapy, mental health and vocational services have been shown to have many benefits, including improved insight, increased understanding, and affirming support. However, since these services may involve discussing many parts of your life, including, at times, the unpleasant aspects, you may also experience uncomfortable feelings. You should be aware that services may or may not lead to direct improvements in your life. You should also be aware that if participation in services induces change in your life, these changes may disrupt your accustomed manner of living and your relationships with others.

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​Attendance Policy

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​It is important to be on time and prepared for all scheduled appointments with EmployAbility/EmpowerAbility. If you pravitely pay for services, you will be charged the full fee for any appointments that are not canceled at least 48 hours in advance.

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​No-Shows and Late Cancelations:

 

​EmployAbility/EmpowerAbility is offering a service to me that is in high demand. Your provider’s time is valuable, and when you schedule an appointment, that time is dedicated to you.

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​Your provider will wait up to 10 minutes for you to arrive for a scheduled appointment. Your provider will no longer be available to meet with you if I am more than 10 minutes late. If you know that you are going to be late for a scheduled appointment, please contact your provider and request a late start time. Your provider is not obligated to approve that request. 

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​If you do not show up for a scheduled appointment without first contacting EmployAbility/EmpowerAbility:
1.       You will be removed from your recurring appointment time, if applicable
2.       You will be responsible for contacting EmployAbility/EmpowerAbility to reschedule your appointment

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You will be discharged from services if you:
•    No call/no show for a scheduled appointment 3 times; OR
•    Reschedule or cancel three appointments with less than a 24-hour notice 3 times; OR
•    No call/no show and/or cancel with short notice, a total of 3 appointments in any combination
 
If you are discharged from services for any reason, including attendance, you may need to be added to a waitlist if you want to re-establish services. This waitlist may be several months long.

 

​TWOFOLD HEALTH

 

General Notice

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​EmployAbility/EmpowerAbility has chosen to use Twofold Health's transcription tool, which provides an automatically generated summarization of sessions. Twofold Health's system is HIPAA-compliant and uses up-to-date encryption methods and multiple layers of security and privacy technology to keep your information private and secure. Twofold will never have access to any identifying information, such as last name, date of birth, Social Security number, or contact information.

 

Details

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1. Data Collection and Use
•    Transcription and Summarization: Recordings of your sessions will be transcribed and summarized by Twofold Health’s HIPAA-compliant 
•     technology. Twofold Health does not store the recordings.
•    Anonymized Data: Twofold Health only keeps anonymized data to help improve the tool. As with any technology, there are certain risks and benefits, which are listed below:
 
2. Risks and Mitigations
•    Confidentiality: All technology carries a risk of information being disclosed. Twofold Health mitigates this risk by ensuring up-to-date technological security and storing the data with minimal identifying information. Your provider will also refrain from entering Protected Health/Identifying Information (PHI), aside from first name, into TwoFold’s system.
•    Bias in Summarization: The system may contain unknown biases in the way it generates the session summary and presents clinical information. This risk is mitigated by your provider’s commitment to review and modify the notes as needed using their clinical expertise.
•    Twofold Health researchers will have access to your de-personalized transcripts (with names and other identifying information removed) solely for the purpose of improving the product and for specific customer support inquiries when requested.

 

3. Benefits
•    Focus on Care: The technology allows your provider to focus more on care.
•    Reduction in Administrative Workload: It removes the need for taking notes during the session, reducing the administrative workload and potentially helping with compassion fatigue.
•    Improved Clinical Insights: The technology may provide additional clinical insights, helping to improve outcomes in the care process.

 

 

NOTICE OF PRIVACY PRACTICES

 

This notice describes how information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

 

You have the right to:

 

Get a copy of your paper or electronic medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

 

Correct your electronic medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why within 60 days.

 

Request confidential communication

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests.

 

Ask us to limit the information we share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

 

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action.

 

File a complaint if you believe your privacy rights have been violated

  • You can complain if you feel we have violated your rights by contacting us.

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/ privacy/hipaa/complaints.

  • We will not retaliate against you for filing a complaint.

  • CCS participants are encouraged to inform their Service Facilitator or Dane County Human Services of any grievances.

  • DVR participants are encouraged to inform their Vocational Case Facilitator of any grievances.

 

We may use and share your information as we:

 

Provide services to you

  • We can use your health information and share it with other professionals who are treating you.

 

Run our organization

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

 

Bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.

 

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

 

Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

 

Work with a medical examiner or funeral director when someone dies

 

Address workers’ compensation, law enforcement, and other government requests

  • We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

 

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

 

We do not do the following:

 

  • We will never contact you for fundraising efforts

  • We do not maintain a client directory

  • We will never sell your personal information

 

Our Responsibilities

 

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

 

Changes to the Terms of this Notice

 

We can change the terms of this notice, and the changes will apply to all information we have about you.

 

The new notice will be available upon request and in our office.

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