プライバシー ポリシー

アメリカでは、連合政府又はワシントン州の法律によって、カウンセリングやアートセラピーを受ける時のプライバシーを守る為の法律が厳しく定められています。

カウンセリングでもし、クライエントになる、あなた又は子供さんのために、他の家族や学校などと話をし、サポートをしてもらえる体制を作る必要がある場合、その人又は組織と話してよいという許可書(Release of Information)に署名をお願いします。

シアトル周辺の日本人社会は意外と狭いもので、偶然、社交的な場でお会いする事があるかと思います。その場合は私の方から、カウンセリングに来られていることを話す事は出来ません。

アメリカの法律で、カウンセラーが他の人に報告しなければならない事が義務付けられているのは、

子供またはシニアの方の虐待が懸念される場合
自分又は他人を傷つけることをカウンセラーに話し、実行する計画がある場合
裁判官や弁護士が法に基づいて、カウンセリングの内容やカルテの内容を請求してきた場合
あなたがカウンセラーに不満があり、州のHealth Departmentの訴えた場合。
医療保険を使う場合は、診断名、治療、治療の変化などが、保険会社に連絡してもよいという書類に署名をお願いします。

予約をメールを通してされる場合、安全な予約のページを使ってご連絡ください。メールで,カウンセリングをされたい内容についてのお答えはできません。予約を取るための日時のみの連絡になります。

以下英語ですが、来院のときに署名していただく書類です。

Notice of Privacy Practice

Information for Clients and Disclosure Statement

Information for Clients and Disclosure Statement

Background and Experience

I am a Licensed Mental Health Counselor and Registered Art Therapist. I have been certified in Washington State since 1997 and licensed since 2001. I gained an M.A. in Art Therapy from New York University in 1992 and frequently attend continuing Education Seminars, including Ethnic Minority Certification Program. I have worked at Outpatient Substance/Alcohol Program in Brooklyn, NY, at the Community Mental Health Center of King County in Seattle, WA, and at Highline School District. I have been in private practice since 2000 and have held several school district contracts for student counseling.

How I practice

I have two different places to practice counseling and art therapy. In the counseling office I use art therapy with limited art supplies and use both psychodynamic and cognitive behavior therapies depending on my clients’ needs. In the studio, I primarily use art therapy and sand tray therapy.
I believe art therapy is a powerful medium to express ourselves. Our creative processes and final art works reflect our mind and help us to recognize our inner conflicts and/or problems and bring creative solutions. Feel free to discuss my approach and your treatment goals and progress.

Appointments

My counseling and art therapy sessions are 40 or 55 minutes long. It is important that you be on time for your appointment, as it is not possible to extend your sessions beyond your scheduled appointment time. Your session time is reserved for you. If you are unable to keep your appointment for any reason, please give me 24-hour advance notice of cancelation, excluding weekends and holidays. If I don’t answer the phone, please leave a message on the voice mail. I don’t accept cancelation by e-mail even if you have signed the consent to allow us to have limited communication through e-mail. Appointments cancelled without 24 hours’ notice will result in a full fee charge for the session (the amount is indicated in the Fee section below).

Fees

I am a network provider for Premera, Regence, First Health Choice , Life Wise and some plans of Kaiser Permanente. Frequently the insurance companies subcontract out with other insurance companies for Behavior Health (counseling) coverage, so please contact your insurance company prior to the intake session.
Insurance coverage for mental health services varies depending on your insurance company and its policy. You will need to sign the Authorization for Treatment Form which includes your consent to release your PHI to your insurance company prior to me contacting your insurance company or sending billing to them. Until I receive verification from your insurance company, you will be responsible for full payment at each session. If your insurance policy has a co-pay requirement, you will be responsible for your co-pay at each visit.

Emergencies

In case of an emergency during office hours, Mondays to Fridays between 9 am and 5 pm, you may reach me through my office number (206) 276-4915. I check for voice mails several times a day but I am not able to attend you immediately if I am with other clients. The 24-hour Crisis Line is available at (206) 461-3222.

Confidentiality

As I discussed in Notice of Privacy Practice, I am dedicated to maintaining the privacy of your Protected Health Information (PHI). All information from sessions will remain confidential. The only way information may be released to any other party is through a specific Consent for Disclosure and/or Exchange of Protected Health Information (PHI) Form. If you choose to use third party coverage (medical insurance), your PHI will be released to your insurance company after you sign the Treatment Agreement Form. The law requires the release of confidential information without consent in certain select circumstances. Please read Notice of Privacy Practices.

Record Keeping

As a licensed Mental Health Counselor, I am required to keep treatment records. If you would like NOT to keep treatment records, with the exception of you or your child’s name, payment method and date of services and disclosure form signed by you and Mineko Takada-Dill, MA,LMHC, please notify me in writing.

Website Privacy Policy

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