Policies

BY BOOKING AN APPOINTMENT WITH MARY SUE ABERNETHY, RDN, MFT, YOU (THE PATIENT) HEREBY CONSENT TO ALL OF THE FOLLOWING:

Appointment Policies

Mary Sue Abernethy, M.A., Licensed Marriage & Family Therapist, MFT# 37179

Registered Dietitian/Nutritionist, RDN #662456

DISCLOSURE STATEMENT

Congratulations, you are making the right decision for self growth, I know it took a lot to get here!

This document contains important information about my professional services & business policies. Please read this information carefully and discuss any questions you have with me. I assume that my clients are self-responsible, and not in need of day-to-day supervision. Clients with such needs may need to seek day treatment facilities.

BENEFITS, & RISKS OF TREATMENT

The majority of individuals who obtain therapy, benefit from the process. Therapy requires a very active effort on your part, which may involve weekly homework. Self-exploration, gaining a better understanding of your behavior, finding ways for dealing with problems & learning new skills, are generally quite useful. However, some risks do exist.

While the benefits of therapy are well known, you may experience unwanted feelings, these are a natural part of the therapy process and often provide the basis for change. Important personal decisions are often a result of therapy. Sometimes a decision that is positive for one family member will be viewed negatively by another family member. There are no guarantees. However, openness, honesty, and willingness assist in a helpful outcome.

USE OF ENERGY MEDICINE, ENERGY PSYCHOLOGY EFT – and/or EMDR.

Since 2005 I have been utilizing a new school of thought in psychology called Energy Psychology and later in 2008 I started using Energy Medicine techniques in my practice. This new direction in counseling utilizes the energy meridian system of the body that is an integral part of Chinese medicine, as well as 2-3 other energy systems known to be directing health in the human body. The energy meridian system was developed and codified by the Chinese 5000 years ago. Clients are instructed to focus on the problem and tap on energy meridian points on the body in a certain order to relieve distress. I also use a causal diagnostic system that utilizes muscle testing to identify which systems require treatment. The diagnostic system requires that I touch an arm or fingers to test muscle strength. This field has been in development for 25 plus years. I continue to add to my skills in energy work and will offer different techniques throughout our work together. Some of the techniques will involve movement exercises to affect other energy systems of the body and holding points associated with the various subtle energy systems – once again it is always your choice whether to do the work I suggest. I believe that energy work with other forms of psychotherapy offer the best chance for healing and minimizing relapses into distress. This style of working is a merging of mind, body, and spirit work. I take an active role in psychotherapy as a "coach" or "consultant" - sharing observations, giving feedback, supporting and challenging behaviors or ideas, offering suggestions, assigning homework and reading when I believe it will be useful. Whether or not counseling is successful may depend on a number of factors such as your willingness to change, the nature of the desired change, the level of trust between the client and therapist, the "fit" between the client and therapist, and other outside influences.

HOURS/AVAILABILITY

Usually a therapy session lasts 60 minutes and is scheduled at the frequency your treatment needs dictate and as mutually agreed upon. Appointments are available Tuesday - Friday 11AM- 6PM and occasional Saturdays 12-4PM.
If you call to leave a message on or after Friday I may not return your call until the following Tuesday from my home office.
For non-emergencies please leave a message for me at 809-0999. Although technology is usually effective, sometimes it is not, so if you do not receive a response within 24 hours please call again. If you e-mail me, be sure to call me and let me know you sent me an e-mail. If I am on vacation there will be a message informing you who to call in my absence, if you can’t wait for my return. After office hours or in a crisis situation, if you feel that you cannot wait for me to return your call, you may contact your primary care physician or the local crisis team (CHOMP - 625-4623 or Natividad 755-4300). You may also want to call crisis intervention services such as Suicide Prevention, Women’s Crisis Center, or simply go to the nearest emergency room. You will be responsible for costs incurred.

CONFIDENTIALITY

The confidentiality (protected privacy) of communications between the client and therapist is important and, in general, is legally protected. Normally, information can be released only with your written permission. However, there are some exceptions where I am required by law to make a report: suspected cases of child abuse or neglect, elder abuse or dependent adult abuse or where a person is a danger to him/herself or another. Understand that in the event that your therapist reasonably believes that you are a danger, physically or emotionally, to yourself or another person, the therapist will attempt to warn the person in danger by contacting him/her in addition to medical and law enforcement personnel.
You should be aware that in most legal proceedings a patient could invoke psychotherapist-patient privilege to protect information about your treatment. However, certain court proceedings may limit your ability to maintain privilege. If you have questions, please contact your attorney.
Billing and/or letters may be mailed or faxed to your home address or number, or I may need to contact you between sessions-please advise me if you have concerns about this in regards to your confidentiality.
Most insurance agreements require you to authorize the therapist to provide clinical information. This may include among other things a diagnosis, description of the problem(s), personal background information, treatment plan or summary, and in some cases, a copy of the entire record in order to render payment for services given to you. When billing insurance, I may utilize a billing service. All pertinent information needed to bill your insurance company mentioned above will be provided to this service. At times employees of the billing service may need to call your insurance company or you for information or collection purposes.

PAYMENT AND FEES

The fee per session is $185.00 per 60 minute session for individuals, couples, and families or 90.00 per 30 minutes session. The fee for group therapy is $40-60 per 1 ½ hour session. The client is fully responsible for all therapy fees and for verifying their insurance coverage for out of network fees. Fees are after each session unless other arrangements have been made in advance. I will bill debit or credit cards electronically. Billing of insurance companies does not guarantee payment and the client will be held accountable for all unpaid balances. There will be a $25 fee for all returned checks due immediately upon notification.
There is no charge for brief telephone conversations either with you or to another person for you, however, calls over 15 minutes long will be billed at the regular rate.
There is a 24-hour cancellation policy. If you or the minor you allow to make appointment for themselves, do not cancel within 24 hours of the scheduled appointment and/or reschedule within the same week of the scheduled appointment, you will be financially responsible to pay a 75.00 fee (not just the co-payment or amount allowed by your insurance company) for the missed appointment. Often others are waiting for an opening in my schedule and thus they and I miss out on using the time slot you do not cancel within 24 hours. Your insurance will not pay for missed sessions.

TERMINATING TREATMENT

You have the right to end your treatment with me at any time. It is important to know that the “match” might not be right between us with no fault to either of us. If it does not appear that you are benefiting from your work with me or if your problem is outside my scope of expertise, I may refer you to alternative professional services that may better meet your needs. A final session for closure is always recommended.

Failure to pay for services rendered may result in treatment termination and/or a referral to a lower cost therapist or agency. Allowing a debt to build is often harmful to the therapeutic relationship. Treatment may also be terminated if the client does not comply with the terms and conditions of treatment, i.e. to refrain from drug use, obtain a psychiatric consultation, come to sessions sober, be willing to achieve mutually agreed upon treatment goals, frequent cancellations etc.

ACKNOWLEDGEMENT

By booking an appointment with Mary Sue Abernethy, you (the patient) consent and agree that you have been informed and hereby acknowledge that Mary Sue Abernethy is an independent therapist and has no professional association with or an affiliation with any other psychotherapist or health care practitioner in this office space. You hereby understand and agree to abide by the contents and terms of this disclosure and request to participate in treatment or evaluation.

Telemedicine Consent

BY BOOKING AN APPOINTMENT WITH MARY SUE ABERNETHY, YOU IMPLICITLY CONSENT TO THE FOLLOWING:

By booking an appointment with Mary Sue Anerbethy, RDN, MFT, you (the Patient) hereby consent to engage in Telehealth with Mary Sue Abernethy, RDN, MFT (Nutritionist and Therapist). You understand that Telehealth is a mode of delivering health care services, including Medical Nutrition Therapy and/or Psychotherapy, via communication technologies (e.g. Internet or phone) to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.

By booking an appointment, you understand and agree to the following:

1. I have a right to confidentiality with regard to my treatment and related communications via Telehealth under the same laws that protect the confidentiality of my treatment information during in-person psychotherapy. The same mandatory and permissive exceptions to confidentiality outlined in the [Disclosure Statement] I received from my therapist also apply to my Telehealth services.

2. I understand that there are risks associated with participating in Telehealth including, but not limited to, the possibility, despite reasonable efforts and safeguards on the part of my therapist, that my psychotherapy sessions and transmission of my treatment information could be disrupted or distorted by technical failures and/or interrupted or accessed by unauthorized persons, and that the electronic storage of my treatment information could be accessed by unauthorized persons.

3. I understand that miscommunication between myself and my therapist may occur via Telehealth.

4. I understand that there is a risk of being overheard by persons near me and that I am responsible for using a location that is private and free from distractions or intrusions.

5. I understand that at the beginning of each Telehealth session my therapist is required to verify my full name and current location.

6. I understand that in some instances Telehealth may not be as effective or provide the same results as in-person therapy. I understand that if my therapist believes I would be better served by in-person therapy, my therapist will discuss this with me and refer me to in-person services as needed. If such services are not possible because of distance or hardship, I will be referred to other therapists who can provide such services.

7.I understand that while Telehealth has been found to be effective in treating a wide range of mental and emotional and physical issues, there is no guarantee that Telehealth is effective for all individuals. Therefore, I understand that while I may benefit from Telehealth, results cannot be guaranteed or assured.

8. I understand that some Telehealth platforms allow for video or audio recordings and that neither I nor my therapist may record the sessions without the other party’s written permission.

9. I have discussed the fees charged for Telehealth with my therapist and agree to them. I have been provided with this information in the Disclosure Statement Form.

10. I understand that my therapist will make reasonable efforts to ascertain and provide me with emergency resources in my geographic area. I further understand that my therapist may not be able to assist me in an emergency situation. If I require emergency care, I understand that I may call 911 or proceed to the nearest hospital emergency room for immediate assistance. I have read and understand the information provided above, have discussed it with my therapist, and understand that I have the right to have all my questions regarding this information answered to my satisfaction.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Mary Sue Abernethy, RDN, MFT understands and agrees to the above advisements, and that the Patient has electronically consented to receiving Psychotherapy or Medical Nutrition Therapy services from this Therapist (Mary Sue Abernethy, RDN, MFT) via Telehealth.

HIPAA

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.

I, Mary Sue Abernethy am required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). I must abide by the terms of this Notice, and I must notify you if a breach of your unsecured PHI occurs. I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

Except for the specific purposes set forth below, I will use and disclose your PHI only with your written authorization (“Authorization”). It is your right to revoke such Authorization at any time by giving me written notice of your revocation.

Uses (Inside Practice) and Disclosures (Outside Practice) Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Written Consent. I can use and disclose your PHI without your Authorization for the following reasons:

1. For your treatment. I can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional. For example, if you are being treated by a physician, psychiatrist, Dietitian or additional psychotherapists, I can disclose your PHI to him or her to help coordinate your care, although my preference is for you to give me an Authorization to do so.

2. To obtain payment for your treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company to get paid for the health care services that I have provided to you, although my preference is for you to give me an Authorization to do so.

3. For health care operations. I can use and disclose your PHI for purposes of conducting health care operations pertaining to my practice, including contacting you when necessary. For example, I may need to disclose your PHI to my attorney to obtain advice about complying with applicable laws.

Certain Uses and Disclosures Require Your Authorization.

4. Psychotherapy or Nutrition Notes. I do keep “psychotherapy and nutrition notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

a. For my use in treating you.

b. For my use in training or supervising other mental health practitioners to help them improve their skills in group, joint, family, nutrition therapy or individual counseling or therapy.

c. For my use in defending myself in legal proceedings instituted by you.

d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

e. Required by law, and the use or disclosure is limited to the requirements of such law.

f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy or nutrition notes.

g. Required by a coroner who is performing duties authorized by law.

h. Required to help avert a serious threat to the health and safety of others.

5. Marketing Purposes. As a psychotherapist/dietitian, I will not use or disclose your PHI for marketing purposes.

6. Sale of PHI. As a psychotherapist/dietitian, I will not sell your PHI in the regular course of my business.

Certain Uses and Disclosures Do Not Require Your Authorization. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

7. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

8. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

9. For health oversight activities, including audits and investigations.

10. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

11. For law enforcement purposes, including reporting crimes occurring on my premises.

12. For coroners or medical examiners, when such individuals are performing duties authorized by law.

13. For research purposes, including studying and comparing the mental or nutritional health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

14. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

15. For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.

16. Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

Certain Uses and Disclosures Require You to Have the Opportunity to Object.

Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you sign a release for and indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOUR RIGHTS REGARDING YOUR PHI You have the following rights with respect to your PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, for health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care

operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES If you think I may have violated your privacy rights, you may file a complaint with me, as the Privacy Officer for my practice, and my address and phone number are: 162 Hacienda Carmel, Carmel, CA. 93940.

My Phone number : 831-809-0999

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:

1. Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201;

2. Calling 1-877-696-6775; or,

3. Visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

I will not retaliate against you if you file a complaint about my privacy practices.

EFFECTIVE DATE OF THIS NOTICE This notice went into effect on September 20, 2013.

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

By using this website and/or by booking an appointment on this website, you hereby acknowledge receipt of the Notice of Privacy Practices that Mary Sue Abernethy has given to you. Mary Sue Abernethy's Notice of Privacy Practices provides information about how she may use and disclose your protected health information. I encourage you to read it in full.

My Notice of Privacy Practices is subject to change. If I change my notice, you may obtain a copy of the revised notice by visiting this website page, or by contacting me at 831-809-0999

If you have any questions about my Notice of Privacy Practices, please contact me at: 831-809-0999 or email me at marysue@pca-llc.net

You hereby acknowledge receipt of the Notice of Privacy Practices of Mary Sue Abernethy, MFT, RDN.

Disclaimers

Welcome to MarySueAbernethy.com. This Disclaimer contains important information that Mary Sue Abernethy, MA, LMFT would like to share with you and for you to understand. Please take a moment to review the following:

The information provided on this website—including articles, blog posts, videos, downloadable materials, and social media content (collectively, the “website”)—is intended for educational and informational purposes only. It is not intended as psychological, medical, or therapeutic advice, and should not be relied upon as a substitute for professional diagnosis, treatment, or mental health care.

While the content may reflect Mary Sue Abernethy’s professional experience and training as a licensed therapist, it is offered as general education and may not apply to your specific circumstances. Engaging with this website or sending electronic communication through contact forms or email does not create a therapist-client relationship. A therapeutic relationship is established only after a formal intake process, informed consent, and mutual agreement to begin therapy.

If you are interested in therapy services, please note that Mary Sue Abernethy provides telehealth therapy only to clients physically located in the state(s) where she is licensed to practice at the time of the session. If you reside outside of those jurisdictions, she cannot provide therapy services to you. However, you may still access the educational materials provided on this site.

Any stories, testimonials, or examples shared on this website are for illustrative purposes only. They do not guarantee or predict any particular results for individuals who engage in therapy or apply the information provided here.

Although every effort is made to ensure that the information shared on this website is accurate and current, Mary Sue Abernethy makes no representations or warranties regarding its completeness, reliability, or suitability for any particular purpose. She accepts no liability for any harm or loss—emotional, psychological, or otherwise—that may arise from your use or misuse of this website or its contents.

If you are experiencing a mental health crisis or emergency, please do not use this website to seek help. Instead, call 988 (Suicide and Crisis Lifeline), or if you are outside the U.S., contact your local emergency services or crisis hotline for immediate support.

By viewing and using this website, you agree to fully release, indemnify, and hold harmless Mary Sue Abernethy, MA, LMFT, and any affiliated individuals or entities from all claims or liability arising from your use of this website or the information contained herein.

By continuing to explore this website, you acknowledge that you have read, understood, and agreed to all of the above terms.

All materials on this website are protected by copyright law. No part of this website may be reproduced, distributed, or transmitted in any form or by any means without prior written permission from Mary Sue Abernethy, MA, LMFT. All rights reserved.

Privacy Policy and Terms and Conditions

What type of information is collected?

We receive, collect and store any information you enter on our website or provide us in any other way. In addition, we collect the Internet protocol (IP) address used to connect your computer to the Internet; login; e-mail address; password; computer and connection information and purchase history. We may use software tools to measure and collect session information, including page response times, length of visits to certain pages, page interaction information, and methods used to browse away from the page. We also collect personally identifiable information (including name, email, password, communications); payment details (including credit card information), comments, feedback, product reviews, recommendations, and personal profile.

How is information collected?

When you conduct a transaction on the website, as part of the process, we collect personal information you give us such as your name, address and email address. Your personal information will be used for the specific reasons stated above only.

Why is personal information collected?

We collect such Non-personal and Personal Information for the following purposes:

To provide and operate the Services;
To provide our Users with ongoing customer assistance and technical support;
To be able to contact our Visitors and Users with general or personalized service-related notices and promotional messages;
To create aggregated statistical data and other aggregated and/or inferred Non-personal Information, which we or our business partners may use to provide and improve our respective services;
To comply with any applicable laws and regulations.

How is information stored, used, shared and disclosed?

Our company is hosted on a SSL secure platform. This platform allows us to sell our products and services to you. Your data may be stored through the platform's data storage, databases and the general applications. They store your data on secure servers behind a firewall.

All direct payment gateways offered by the website platform and used by our company adhere to the standards set by PCI-DSS as managed by the PCI Security Standards Council, which is a joint effort of brands like Visa, MasterCard, American Express and Discover. PCI-DSS requirements help ensure the secure handling of credit card information by our store and its service providers.

How do we communicate with site visitors?

We may contact you to notify you regarding your services, to troubleshoot problems with your account, to resolve a dispute, to collect fees or monies owed, to poll your opinions through surveys or questionnaires, to send updates about our services, or as otherwise necessary to contact you to enforce our User Agreement, applicable national laws, and any agreement we may have with you. For these purposes we may contact you via email, telephone, text messages, and postal mail.

How do we use cookies and other tracking tools?

While we do not use cookies or tracking tools, we reserve the right to implement these third-party services, such as Google Analytics or other applications in the future.

How can site visitors withdraw their consent?

If you want to remove yourself as a Site Member, please contact us.

We reserve the right to modify this privacy policy at any time, so please review it frequently. Changes and clarifications will take effect immediately upon their posting on the website.

Questions and our contact information

If you would like to: access, correct, amend or delete any personal information we have about you, you are invited to contact us.