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Corporate Notice to the Public and Potential Clients

In accordance with California Statutes and Regulations pertaining to the practice of clinical social work, article 5, S 4998.2, please be informed that Rhizome Wellness Collective is a California registered fictitious business name for the purposes of branding and advertising. Rhizome Wellness Collective is a representation of Rhizome Wellness Collective Licensed Clinical Social Work Inc, a California Professional corporation engaged in the provision of clinical social work. Dylan McClure, LCSW, California license number 92417 is the president and sole shareholder of the Professional Corporation. February 25, 2024.

 

Good Faith Estimate Notice to Clients and Perspective Clients

Under the law, health care providers need to give clients without insurance or those who do not use insurance an estimate of the expected charges for medical services, including psychotherapy services.  The new law gives you the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your  care provider, for a Good Faith Estimate before you schedule a service, or at any time during treatment.  If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Please save a copy or picture of your Good Faith Estimate.  For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises

 

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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We are required by law to provide this information to all individuals that request and obtain services from our practice. We do this by providing this Notice in our patient information packet. Should our privacy practices change in the future, we will notify clients by promptly posting our new policy and by making revised Notices available to all clients

How we use information about you:

  • We ask each client to complete an Informed Consent for Psychotherapy form. This consent gives us permission to use and disclose your individual information for healthcare and business operations. This means you allow us to share your information when it is needed to provide care, coordinate health services, and obtain payment for those services.

  • We request from you only the information that we need for health care and business operations. This information includes your health history and basic personal information. Examples of this are your address, phone number, insurance information, social security number, and family income.

  • We limit access to your information to those employees that need the information in order to do their jobs. For example, billing staff use your personal information in order to bill for services, but do not access your personal health history.

  • We may share information about you with others that are involved in your health care. For example, we send basic information (such as services received and diagnoses) to insurances or programs that pay for the services.

  • We disclose some information in very specific situations that are required by law for example to report abuse, violence or neglect.

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When we need your permission to disclose information:

Any release of information about you that does not fall into the above categories requires a written authorization from you. You will be asked to complete an Authorization to Release form and to tell me exactly what sections of your information we can release, and to whom. If this form is not correct and complete, we can not release your individual information.

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Your Rights Concerning your individual information:

You have certain specific rights to control your individual health information. These rights are summarized below. You may contact us for more information about any of these rights.

  • Right to revoke authorization – You have the right to revoke a previously made authorization to release.

  • Right to request restrictions on disclosure – You have the right to request that we not disclose all or part of your individual information, even for the health care and business operations discussed above. As a health care provider, we are not required to agree to your request, and we do not encourage any restriction that would impact the sharing of information that is important to maintaining your health. However, there may be situations when such a restriction is appropriate. You are encouraged to discuss this with us, and we will provide you with more information should a restriction be necessary.

  • Right to access your health care records – You have the right to inspect your health care records in the presence of a health care provider, and to have a copy of those records.

  • Right to amend or correct your health care records – You have the right to provide a written addendum to correct any portion of your health care record that you feel is inaccurate.

  • Right to know how your records have been disclosed – You have the right to receive a history of the disclosures of your health care records.

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What to do if you suspect that your privacy has been violated:

We encourage you to make a report any time that you feel your privacy may have been violated. No individual will ever be discriminated against for making a report.

You may make a report in the following ways:

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on 2/7/2024

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