Psychotherapist-Patient Agreement

Psychotherapist-Patient Agreement

Charlotte Center for Balanced Living is in compliance with the Health Insurance Portability and Accountability Act of 1996. We have taken great steps to ensure the greatest level of privacy is afforded to each individual. Part of the new patient paperwork includes a ROI (“Release of Information”) page that is required in order for us to speak with any other provider of your choice. Sometimes the provider that referred you to our center will call to verify you attended your appointment. We can not confirm or deny anyone is a patient (or potential patient) without that provider’s name on the ROI. Your right of access to your PHI (protected health information) includes information used to identify yourself. Psychotherapy notes are not subject to your right to inspect and/or obtain a copy of. Transfer of records would go directly from provider to provider upon signed ROI. Upon request, ample information can be supplied to you for further review regarding the compliance of HIPAA at Charlotte Center for Balanced Living.

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