Random Law/Ethics Flashcards
Obtaining clients “Informed Consent” for treatment is legally + ethically mandated, except for 2 reasons to treat without consent….?
Reasons to treat without consent:
- Crisis situation
- When a client refuses informed consent
LEGAL and ETHICAL issues
R-A-P-I-S-T R - R - F S-I-C
R-elease of info A-dvertising P-rivilege I-nformed consent S-exual relations T-elehealth
R-ecords
R-eferrals
F-ees
S-uicide
I-nsurance
C-onfidentiality
LEGAL issues
ABC- CDE- FHI - IMP- RRR - SSS - ST
A-dvertising
B-usiness practices
C-onfidentiality
C-hild abuse
D-anger to others
E-lder abuse
F-ees
H-IPPA
I-nformed consent
I-nsurance
M-inors
P-rivelege
R-elease of info
R-eferrals
R-ecords
S-exual relations
S-uicide
S-tandard of care
S-cope of practice
T-elehealth
ETHICAL issues
(23)
A-CCC-DD-FF-GG-III-PP-RRR-SSSS-TT
Advertising Confidentiality Consultation Countertransference Dual Relationships Diversity Fees Families/couples Gifts Groups Informed consent Insurance Issues w/colleagues Privilege Personal problems Records Referrals Release of info Sexual relations Suicide Scope of competence Self-determination Termination Telehealth
Telemedicine informed consent can be verbal or written, and MUST include:
Telemedicine informed consent can be verbal or written, and MUST include:
- procedures for crisis/technology errors
- risks
Prior to each session of Telemedicine…the Therapist must:
Prior to each session of Telemedicine…the Therapist must:
- Verify Ct Name + location (verbal + document)
- Reassess Appropriateness
- Ensure Confidentiality + Secure Communication
It is illegal for therapist to provide telemedicine to a client that is out of state, unless they are traveling temporarily , but Therapist must first…
In order to provide telemedicine with client traveling temporarily out of state Th must:
- Check states licensing board if teletherapy is permitted
- must receive informed consent specific to tele-therapy.
Prior to start of telemedicine Th must…
Prior to start of telemedicine Th must…
- Assess appropriateness
- Verbal or written consent (documented)
- Risks/limitations
- License info
- Local resources/emergency services (documented)
IN order to use insurance, Ct needs
Diagnosis (used only for medical necessity)
When using insurance, Therapist have a duty to…
Th have duty to inform Ct of how info is managed
Th have ethical duty (not legal) to appeal insurance if Tx is denied or allotted sessions are up
In addition to Therapists ethical duty to appeal insurance, they must also…
Discuss fee options & Ct’s responsibility to pay (incase insurance denies)
When using insurance, It is considered illegal (fraud) to…
When using insurance, It is considered illegal (fraud) to…
- Give or change diagnosis in order to use insurance
- Bill both Ct’s insurance
- Bill for missed sessions
- Charge higher for due to insurance
If using insurance, Therapist must inform insurance of..
fee changes & unlicensed status
advertising false skills & experience =
advertising false skills & experience =
ILLEGAL + UNETHICAL
all advertisements MUST include:
all advertisements MUST include:
License # and Title
Advertisement with fictitious business name require..
DBA - ‘doing business as’
Advertisement with fictitious business name require..
(DBA - ‘doing business as’)
NAME + LICENSE = of OWNER
When advertising, Th must avoid…
When advertising, Th must avoid…
- using client testimonial (unethical)
- stating “expertise” without qualifying training
- statements of false expectations (better in 10 days)
Withholding client records for non-payment is…
ILLEGAL
Informed consent for Fees includes:
Informed consent for Fees includes:
- payment methods accepted
- billing schedule
- fee adjustment
- non-payment consequences
Th should resolve Non-payment of fees by…
Th should resolve Non-payment of fees by…
- review fee agreement + set up payment plan
- If Ct not in crisis = Discuss Termination
- Submit to collection agency
As a last resort, Th submits Ct to collection agency for non-payment and is allowed to share…
As a last resort, Th submits Ct to collection agency for non-payment and is allowed to share…
Name + Amount Owed
In order to raise Ct fees, Th should…
give client 3 months written notice
must inform insurance of any fee adjustment
It is acceptable to terminate for non-payment of fees
True; only if Ct is not in crisis
Bartering is ONLY ACCEPTABLE IF …
Bartering is ONLY ACCEPTABLE IF …
- client initiated
- part of cultural norm
- boundary violations are considered
(best to barter goods rather than services)
If new client cannot afford Ct fees…
refer out
ongoing client can’t afford due to temporary situation ‘job loss’ = reduce fee/ provide sliding scale
Mandated exceptions to Confidentiality..
Mandated exceptions to Confidentiality..
1) Child + Elder/Dependent
abuse/neglect
2) Danger to others
3) Signed release of info
4)*Court order
(subpoena by court/judge)
5) BBS Investigation
(ethical violation)
6) Search warrant for office
7) Client death–coroner
investigation
8) Request for records by
client or rep
9) Patriot act to share records
Third Parties who attend therapy
Th inform visitor they’re not a Ct and therefore not entitled to confidentiality or privilege under the law.
(Th respects confidential nature of session, & visitor should not expect legal protections afforded to Ct.
The Patriot Act
mandated exception to confidentiality: requires therapists (and others) to provide (FBI) agents with client information AND prohibits therapist from disclosing to the client that the FBI sought or obtained the items under the Act.
Confidentiality - allowed, but not mandated exceptions
Confidentiality - allowed, but not mandated exceptions
1) Danger to self
2) Crisis communicate w/providers
3) payment responsibility
4) insurance audit
5) crime against Th
Holder of Privilege
always client initially (all members of tx unit)
Minors - guardian ad litem (not parents-unless given guardian ad litem status)
Conservator - shares privilege with client (ct never loses privilege)
Deceased client - personal representative given by court
Incarcerated ct - still has privilege (allowed to access records / minors records)
10 Exceptions to Privilege
- claims emotional condition/injury in court
- shares confidential information
- 15yr (or younger) is victim of a crime
- seeks therapy to escape or commit crime
- Th appointed by court to examine ct
- Breach of Duty (Th/Ct sues)
- Determine sanity in criminal case
- Ct requests evaluation to establish competence
- Danger to others/self/property & sharing necessary to prevent harm
- coroner investigation (public health inspection)
Subpoena
- contact client
- always assert privilege (until court orders you to do otherwise)
- IF Ct wants to share = must sign waiver to privilege (if Th believes it’s harmful - discuss concerns with client)
Court/judge ordered - must give records
lawyer - assert privilege
subpoena to testify in court = consult with lawyer
Privilege: If judge orders records for past client that is unrelated to a crime, Th can…
advocate to submit limited information
HIPAA stands for? and mustbe complied by?
• Standard medical procedures for medical records confidentiality (billing/payment)
Electronic communication + third party payers (insurance, managed care)
(ex. use insurance but not electronically = not HIPPA)
HIPAA info shared
medical (psychotherapy RECORDS, progress notes)
Diagnosis Treatment plan start/end times interventions progress notes
HIPAA timeline for accessing records
Same as records
5 days = inspect
10 = summary
15 = copy
4 HIPAA Requirements
privacy,
electronic transaction standards,
security
national provider identifier numbers
Client must sign & be given copy of “Notice of Privacy Practices” prior to therapy (must be posted in office/website)
NPI - 10 digit number used for all transactions
HIPAA– 5 client privacy rights
1) request restrictions on use/disclosure of protected health info (PHI)
2) receive confidential communication from providers
3) inspect & receive copy of PHI
4) right to amend their PHI
5) to receive a copy of the Th’s Notice of Privacy Practices
*PHI - protected health info
what is HIPAA’s “Notice of Privacy Practices”
how ct’s information is used
Th duty to inform client
When Therapist Should Refer…
- Ct needs care outside Th scope of practice (ex. refer for meds/ psych-ct stopped meds)
- Ct issues are outside Th scope of competence
- Ct can’t afford Th fee (or Th has full client load)
- Th terminate w/ct
- domestic violence = Th must give safety resources + document in notes
Illegal to receive/accept compensation for referrals
true (conflict of interest)
inappropriate countertransference
sexual arousal, extreme dislike
illegal to have sexual contact with client
currently & within 2 years of termination
unethical–prior sex w/client; sex with friends/relatives of client
client invitations to Th, are only appropriate if…
it relates to client treatment goals
eats lunch with eating disorder ct
If ct wants to terminate & Th disagrees
Th acknowledges ct right to terminate
Th doesn’t need to provide referrals when…
If Ct has met Tx goals (unethical to continue therapy if no reason)
Release of information must include
the specific info shared
name of Th/provider
end date
Ct’s right to have copy
*font must be min 14pt font
If Ct requests records & Th determines its high risk for Ct to access records…Th must
document date of Ct’s request
specific potential detrimental consequences
notify Ct of Th denial access to records
Ct right to review with other professional (must sign release)
Timeline for Elder/Dependent Abuse reporting…
outside facility = call police + report 2 days
in facility non-physical abuse = call police + 2 days
*unless:
physical non injury = 1 day
physical by resident w/dementia = 1 day
**physical serious injury = 2 hours
Types of elder/dependent abuse
Physical:
Assault / sexual abuse
Physical restraints + overly medicated
deprivation of food/water
Abandonment:
caregiver willful withdrawal of support (when care/support is needed)
isolation (ex. restricted from social contact use phone, see friends)
Neglect:
failure to provide basic hygiene (ex. won’t change bedding)
no meds
self-neglect (ex. elderly lives alone & doesn’t care for self/home, ‘abnormal’ behavior)
Financial:
not allowed access to money, stealing money
Abduction:
take elderly out of state against will
Emotional abuse = *optional report explore impact on Ct’s mental health
threats, swearing
Th must notify BBS within 30 days of
Th must notify BBS within 30 days of = change of name/address + any convictions (DUI)
