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Terms and Policy

Cancellation/Late/Sick Policy
Late/Cancellation/Sick Policy

If a cancellation is made by the client less than 24 hours prior to the scheduled appointment, the full price of the session will be charged to the corresponding credit card on file.* If you are more than 15 minutes late or do not show up for the appointment without notifying the therapist, the session will be cancelled and you will be billed the entire cost of the session. The only exception to this is an emergency (i.e. vehicle/transportation difficulties, family emergency, illness of the client or close family member), in which case the client must inform the therapist of their circumstances as soon as possible by calling 717-969-2208. In the event that the therapist must cancel the appointment, there will be no fee charged and notification will be given as soon as possible. Please be sure to keep your contact information up to date. *A valid credit card will be required to keep on file for this purpose regardless of regular session payment method (i.e. medical insurance).

If at any time you/the client or a household member is sick with a contagious illness or rash (i.e. cold/flu, pink eye, poison ivy, fever, sore throat, cough, lice, dizziness, chills, diarrhea, vomiting, etc.) please cancel your appointment as soon as possible and reschedule for a later date. Please contribute to the due diligence of securing the wellness of staff, clients, and all other patrons of Art Therapy Studios.

Art Therapy Studios appreciates and enjoys your company, and as a reminder please adhere to the following:
-Respect the sanctuary of the space, the space of others, the furniture, tools and materials as we need to share amongst many.
-Respect the space, meaning, materials and signs surrounding the artwork on display, some are very fragile (for your safety and for your wallet- You break it, you buy it).
-Respect the cleanliness and orderliness of the space and clean up after yourself (food, beverages, and therapy pets are permitted as needed).
-All children under the age of 14 must be accompanied by an adult and closely supervised for their entire stay (with exception to individual therapy sessions).

Please be aware that a parent/guardian is required to stay on premises at all times with children under 14 (as well as the time during session if the child is the client). In the event of an emergency and the parent is unavailable, staff at Art Therapy Studios will administer first aid as needed, call 911 and wait for an ambulance to transport the child to the nearest emergency room.
( Type Full Name )
HIPAA Policy & Terms
I. COMMITMENT TO YOUR PRIVACY: Art Therapy Studios (including Brenda Cunningham, MS, ATR-BC, LPC and staff) is dedicated to maintaining the privacy of your protected health information (PHI). PHI is information that may identify you and that relates to your past, present or future physical or mental health condition and related health care services. This Notice of Privacy Practices (“Notice”) is required by law to provide you with the legal duties and the privacy practices that Art Therapy Studios (including Brenda Cunningham, MS, ATR-BC, LPC and staff) maintains concerning your PHI. It also describes how medical and mental health information may be used and disclosed, as well as your rights regarding your PHI. Please read carefully and discuss any questions or concerns with your therapist.

II. LEGAL DUTY TO SAFEGUARD YOUR PHI: By federal and state law, Art Therapy Studios is required to ensure that your PHI is kept private. This Notice explains when, why, and how Art Therapy Studios would use and/or disclose your PHI. Use of PHI means when Art Therapy Studios shares, applies, utilizes, examines, or analyzes information within its practice; PHI is disclosed when Art Therapy Studios releases, transfers, gives, or otherwise reveals it to a third party outside of and other than the employees and associates of Art Therapy Studios. With some exceptions, Art Therapy Studios may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, Art Therapy Studios is always legally required to follow the privacy practices described in this Notice.

III. CHANGES TO THIS NOTICE: The terms of this notice apply to all records containing your PHI that are created or retained by Art Therapy Studios. Please note that Art Therapy Studios reserves the right to revise or amend this Notice of Privacy Practices. Any revision or amendment will be effective for all of your records that Art Therapy Studios has created or maintained in the past and for any of your records that Art Therapy Studios may create or maintain in the future. Art Therapy Studios will have a copy of the current Notice in the office, and you may request a copy of the most current Notice at any time. The date of the latest revision will always be listed at the end of Art Therapy Studios' Notice of Privacy Practices.

IV. HOW YOUR NAME MAY USE AND DISCLOSE YOUR PHI: Art Therapy Studios will not use or disclose your PHI without your written authorization, except as described in this Notice or as described in the “Consent to Release and Obtain Information” and "Consent to Use Recording Devices and Photograph Artwork" documents. Below you will find the different categories of possible uses and disclosures with some examples.

1. For Treatment: Art Therapy Studios may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If you are also seeing a psychiatrist for medication management, Art Therapy Studios may disclose your PHI to her/him in order to coordinate your care. Except for in an emergency, Art Therapy Studios will always ask for your authorization in writing prior to any such consultation.

2. For Health Care Operations: Art Therapy Studios may disclose your PHI to facilitate the efficient and correct operation of its practice. Example: Quality control - Art Therapy Studios may provide your PHI to its office personnel, accountants, practice consultants, attorneys and others to make sure that Art Therapy Studios is in compliance with applicable practices and laws. It is Art Therapy Studios' practice to conceal all client names in such an event and maintain confidentiality. However, there is still a possibility that your PHI may be audited for such purposes.

3. To Obtain Payment for Treatment: Art Therapy Studios may use and disclose your PHI to bill and collect payment for the treatment and services Art Therapy Studios provided you. Example: Art Therapy Studios might send your PHI to your insurance company or managed health care plan, in order to get payment for the health care services that have been provided to you. Art Therapy Studios could also provide your PHI to billing companies, claims processing companies, and others that process health care claims for Art Therapy Studios if either you or your insurance carrier are not able to stay current with your account. In this latter instance, Art Therapy Studios will always do its best to reconcile this with you first prior to involving any outside agency.

4. Employees and Business Associates: There may be instances where services are provided to Art Therapy Studios by an employee or through contracts with third-party “business associates.” Whenever an employee or business associate arrangement involves the use or disclosure of your PHI, Art Therapy Studios will have a written contract that requires the employee or business associate to maintain the same high standards of safeguarding your privacy that is required of Art Therapy Studios.

V. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES – Art Therapy Studios may use and/or disclose your PHI without your consent or authorization for the following reasons:

1. Law Enforcement: Subject to certain conditions, Art Therapy Studios may disclose your PHI when required by federal, state, or local law; judicial, board, or administrative proceedings; or, law enforcement. Example: Art Therapy Studios may make a disclosure to the appropriate officials when a law requires Art Therapy Studios to report information to government agencies, law enforcement personnel and/or in an administrative proceeding.
2. Lawsuits and Disputes: Art Therapy Studios may disclose information about you to respond to a court or administrative order or a search warrant. Art Therapy Studios may also disclose information if an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel. Art Therapy Studios will only do this if efforts have been made to tell you about the request and you have been provided an opportunity to object or to obtain an appropriate court order protecting the information requested.
3. Public Health Risks: Art Therapy Studios may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, disability, to report births and deaths, and to notify persons who may have been exposed to a disease or at risk for getting or spreading a disease or condition.
4. Food and Drug Administration (FDA): Art Therapy Studios may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
5. Serious Threat to Health or Safety: Art Therapy Studios may disclose your PHI if you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others, and if Art Therapy Studios determines in good faith that disclosure is necessary to prevent the threatened danger. Under these circumstances, Art Therapy Studios may provide PHI to law enforcement personnel or other persons able to prevent or mitigate such a serious threat to the health or safety of a person or the public.
6. Minors: If you are a minor (under 18 years of age), Art Therapy Studios may be compelled to release certain types of information to your parents or guardian in accordance with applicable law.
7. Abuse and Neglect: Art Therapy Studios may disclose PHI if mandated by Pennsylvania State Childline, elder, or dependent adult abuse and neglect reporting laws. Example: If Art Therapy Studios has a reasonable suspicion of child abuse or neglect, Art Therapy Studios is a mandated reporter and will report this to the appropriate Department of Child and Family Services in the County where the alleged abuse/neglect occurred.
8. Coroners, Medical Examiners, and Funeral Directors: Art Therapy Studios may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person, determine the cause of death or other duties as authorized by law. Art Therapy Studios may also disclose PHI to funeral directors, consistent with applicable law, to carry out their duties.
9. Communications with Family, Friends, or Others: Art Therapy Studios may release your PHI to the person you named in your Durable Power of Attorney for Health Care (if you have one), to a friend or family member who is your personal representative (i.e., empowered under state or other law to make health-related decisions for you), or any other person you identify, relevant to that person’s involvement in your care or payment related to your care. In addition, Art Therapy Studios may disclose your PHI to an entity assisting in disaster relief efforts so that your family can be notified about your condition.
10. Military and Veterans: If you are a member of the armed forces, Art Therapy Studios may release PHI about you as required by military command authorities. Art Therapy Studios may also release PHI about foreign military personnel to the appropriate military authority.
11. National Security, Protective Services for the President, and Intelligence Activities: Art Therapy Studios may release PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, to conduct special investigations for intelligence, counterintelligence, and other national activities authorized by law.
12. Correctional Institutions: If you are or become an inmate of a correctional institution, Art Therapy Studios may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.
13. For Research Purposes: In certain limited circumstances, Art Therapy Studios may use information you have provided for medical/psychological research, but only with your written authorization. The only circumstance where written authorization would not be required would be if the information you have provided could be completely disguised in such a manner that you could not be identified, directly or through any identifiers linked to you. The research would also need to be approved by an institutional review board that has examined the research proposal and ascertained that the established protocols have been met to ensure the privacy of your information.
14. For Workers' Compensation Purposes: Art Therapy Studios may provide PHI in order to comply with Workers' Compensation or similar programs established by law.
15. Appointment Reminders: Art Therapy Studios is permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternative or other health-related benefits and services that you may need or that may be of interest to you.
16. Health Oversight Activities: Art Therapy Studios may disclose health information to a health oversight agency for activities such as audits, investigations, inspections, or licensure of facilities. These activities are necessary for the government to monitor the health care system, government programs and compliance with laws. Example: When compelled by U.S. Secretary of Health and Human Services to investigate or assess Art Therapy Studios compliance with HIPAA regulations.
17. If Disclosure is Otherwise Specifically Required by Law.

VI. OTHER USES AND DISCLOSURES REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION: In any other situation not covered by this notice, Art Therapy Studios will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying Art Therapy Studios in writing of your decision. You understand that Art Therapy Studios is unable to take back any disclosures it has already made with your permission, Art Therapy Studios will continue to comply with laws that require certain disclosures, and Art Therapy Studios is required to retain records of the care that its therapist has provided to you.

1. The Right to See and Get Copies of Your PHI: In general, you have the right to see your PHI that is in Art Therapy Studios possession, or to get copies of it; however, you must request it in writing. If Art Therapy Studios does not have your PHI, but knows who does, you will be advised how you can get it. You will receive a response from Art Therapy Studios within 30 days of receiving your written request. Under certain circumstances, Art Therapy Studios may feel it must deny your request, but if it does, Art Therapy Studios will give you, in writing, the reasons for the denial. Art Therapy Studios will also explain your right to have its denial reviewed. If you ask for copies of your PHI, you will be charged not more than $.25 per page and the fees associated with supplies and postage. Art Therapy Studios may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.
2. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask that Art Therapy Studios limit how it uses and discloses your PHI. While Art Therapy Studios will consider your request, it is not legally bound to agree. If Art Therapy Studios does agree to your request, it will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that Art Therapy Studios is legally required or permitted to make.
3. The Right to Choose How Art Therapy Studios Sends Your PHI to You: It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via email instead of by regular mail). Art Therapy Studios is obliged to agree to your request providing that it can give you the PHI, in the format you requested, without undue inconvenience.
4. The Right to Get a List of the Disclosures. You are entitled to a list of disclosures of your PHI that Art Therapy Studios has made. The list will not include uses or disclosures to which you have specifically authorized (i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes, or to corrections or law enforcement personnel. The request must be in writing and state the time period desired for the accounting, which must be less than a 6-year period and starting after September 10, 2016.
Art Therapy Studios will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list will include the date of the disclosure, the recipient of the disclosure (including address, if known), a description of the information disclosed, and the reason for the disclosure. Art Therapy Studios will provide the list to you at no cost, unless you make more than one request in the same year, in which case it will charge you a reasonable sum based on a set fee for each additional request.
5. The Right to Amend Your PHI: If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that Art Therapy Studios correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of Art Therapy Studios receipt of your request. Art Therapy Studios may deny your request, in writing, if it finds that the PHI is: (a) correct and complete, (b) forbidden to be disclosed, (c) not part of its records, or (d) written by someone other than Art Therapy Studios denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and Art Therapy Studios denial will be attached to any future disclosures of your PHI. If Art Therapy Studios approves your request, it will make the change(s) to your PHI. Additionally, Art Therapy Studios will tell you that the changes have been made and will advise all others who need to know about the change(s) to your PHI.
6. The Right to Get This Notice by Email: You have the right to get this notice by email. You have the right to request a paper copy of it as well.
7. Submit all Written Requests to: Art Therapy Studios, Brenda Cunningham, 110 W. Eisenhower Dr. Suite A, Hanover, PA 17331.

VIII. COMPLAINTS*: If you are concerned your privacy rights may have been violated, or if you object to a decision Art Therapy Studios made about access to your PHI, you are entitled to file a complaint. You may also send a written complaint to the Secretary of the Department of Health and Human Services Office of Civil Rights. Dr. Karen Murphy is the Secretary of Health and Ted Dallas is the Secretary of the Department of Human Services in Pennsylvania. Under no circumstances will you be penalized or retaliated against for filing a complaint.

*Please discuss any questions or concerns with your therapist.

If you do not agree and consent to this HIPAA Policy, Art Therapy Studios cannot provide therapeutic services to you. Please print a copy for your records.
( Type Full Name )