Local Time / Timezone
7:25 am, Sat Apr 20: Kabul (AFT)
4:55 am, Sat Apr 20: Tirane (CET)
3:55 am, Sat Apr 20: Algiers (CET)
3:55 pm, Fri Apr 19: Pago Pago (SST)
4:55 am, Sat Apr 20: Andorra (CET)
3:55 am, Sat Apr 20: Luanda (WAT)
10:55 pm, Fri Apr 19: Anguilla (AST)
10:55 pm, Fri Apr 19: Antarctica - Palmer (CLT)
5:55 am, Sat Apr 20: Antarctica - Syowa (SYOT)
8:55 am, Sat Apr 20: Antarctica - Mawson (MAWT)
8:55 am, Sat Apr 20: Antarctica - Vostok (VOST)
9:55 am, Sat Apr 20: Antarctica - Davis (DAVT)
10:55 am, Sat Apr 20: Antarctica - Casey (WST)
12:55 pm, Sat Apr 20: Antarctica - DumontDUrville (DDUT)
2:55 pm, Sat Apr 20: Antarctica - McMurdo (NZST)
2:55 pm, Sat Apr 20: Antarctica - South Pole (NZST)
10:55 pm, Fri Apr 19: Antigua (AST)
6:55 am, Sat Apr 20: Yerevan (AMT)
10:55 pm, Fri Apr 19: Aruba (AST)
10:55 am, Sat Apr 20: Australia - Perth (WST)
12:25 pm, Sat Apr 20: Australia - Adelaide (CST)
12:25 pm, Sat Apr 20: Australia - Broken Hill (CST)
12:25 pm, Sat Apr 20: Australia - Darwin (CST)
12:55 pm, Sat Apr 20: Australia - Brisbane (EST)
12:55 pm, Sat Apr 20: Australia - Hobart (EST)
12:55 pm, Sat Apr 20: Australia - Lindeman (EST)
12:55 pm, Sat Apr 20: Australia - Melbourne (EST)
12:55 pm, Sat Apr 20: Australia - Sydney (EST)
1:25 pm, Sat Apr 20: Australia - Lord Howe (LHST)
4:55 am, Sat Apr 20: Vienna (CET)
6:55 am, Sat Apr 20: Baku (AZT)
10:55 pm, Fri Apr 19: Nassau (EST)
5:55 am, Sat Apr 20: Bahrain (AST)
8:55 am, Sat Apr 20: Dhaka (BDT)
10:55 pm, Fri Apr 19: Barbados (AST)
4:55 am, Sat Apr 20: Minsk (EET)
4:55 am, Sat Apr 20: Brussels (CET)
8:55 pm, Fri Apr 19: Belize (CST)
3:55 am, Sat Apr 20: Porto-Novo (WAT)
11:55 pm, Fri Apr 19: Bermuda (AST)
8:55 am, Sat Apr 20: Thimphu (BTT)
10:55 pm, Fri Apr 19: La Paz (BOT)
4:55 am, Sat Apr 20: Sarajevo (CET)
4:55 am, Sat Apr 20: Gaborone (CAT)
9:55 pm, Fri Apr 19: Eirunepe (ACT)
9:55 pm, Fri Apr 19: Rio Branco (ACT)
10:55 pm, Fri Apr 19: Boa Vista (AMT)
10:55 pm, Fri Apr 19: Cuiaba (AMT)
10:55 pm, Fri Apr 19: Manaus (AMT)
10:55 pm, Fri Apr 19: Porto Velho (AMT)
11:55 pm, Fri Apr 19: Araguaina (BRT)
11:55 pm, Fri Apr 19: Belem (BRT)
11:55 pm, Fri Apr 19: Fortaleza (BRT)
11:55 pm, Fri Apr 19: Maceio (BRT)
11:55 pm, Fri Apr 19: Recife (BRT)
11:55 pm, Fri Apr 19: Sao Paulo (BRT)
12:55 am, Sat Apr 20: Noronha (FNT)
8:55 am, Sat Apr 20: Chagos (IOT)
10:55 am, Sat Apr 20: Brunei (BNT)
5:55 am, Sat Apr 20: Sofia (EET)
2:55 am, Sat Apr 20: Ouagadougou (GMT)
4:55 am, Sat Apr 20: Bujumbura (CAT)
10:55 pm, Fri Apr 19: Curacao (AST)
9:55 am, Sat Apr 20: Phnom Penh (ICT)
3:55 am, Sat Apr 20: Douala (WAT)
6:55 pm, Fri Apr 19: Dawson (PST)
6:55 pm, Fri Apr 19: Whitehorse (PST)
7:55 pm, Fri Apr 19: Dawson Creek (MST)
7:55 pm, Fri Apr 19: Vancouver (PST)
8:55 pm, Fri Apr 19: Regina (CST)
8:55 pm, Fri Apr 19: Swift Current (CST)
8:55 pm, Fri Apr 19: Cambridge Bay (MST)
8:55 pm, Fri Apr 19: Edmonton (MST)
8:55 pm, Fri Apr 19: Inuvik (MST)
8:55 pm, Fri Apr 19: Yellowknife (MST)
9:55 pm, Fri Apr 19: Rainy River (CST)
9:55 pm, Fri Apr 19: Winnipeg (CST)
9:55 pm, Fri Apr 19: Rankin Inlet (EST)
10:55 pm, Fri Apr 19: Iqaluit (EST)
10:55 pm, Fri Apr 19: Montreal (EST)
10:55 pm, Fri Apr 19: Nipigon (EST)
10:55 pm, Fri Apr 19: Pangnirtung (EST)
10:55 pm, Fri Apr 19: Thunder Bay (EST)
11:55 pm, Fri Apr 19: Glace Bay (AST)
11:55 pm, Fri Apr 19: Goose Bay (AST)
11:55 pm, Fri Apr 19: Halifax (AST)
12:25 am, Sat Apr 20: St Johns (NST)
1:55 am, Sat Apr 20: Cape Verde (CVT)
9:55 pm, Fri Apr 19: Cayman (EST)
3:55 am, Sat Apr 20: Bangui (WAT)
3:55 am, Sat Apr 20: Ndjamena (WAT)
8:55 pm, Fri Apr 19: Easter (EAST)
10:55 pm, Fri Apr 19: Santiago (CLT)
10:55 am, Sat Apr 20: Chongqing (CST)
10:55 am, Sat Apr 20: Harbin (CST)
10:55 am, Sat Apr 20: Kashgar (CST)
10:55 am, Sat Apr 20: Shanghai (CST)
10:55 am, Sat Apr 20: Urumqi (CST)
9:55 am, Sat Apr 20: Christmas (CXT)
9:25 am, Sat Apr 20: Cocos (CCT)
9:55 pm, Fri Apr 19: Bogota (COT)
5:55 am, Sat Apr 20: Comoro (EAT)
3:55 am, Sat Apr 20: Brazzaville (WAT)
3:55 am, Sat Apr 20: Kinshasa (WAT)
4:55 am, Sat Apr 20: Lubumbashi (CAT)
4:55 pm, Fri Apr 19: Rarotonga (CKT)
8:55 pm, Fri Apr 19: Costa Rica (CST)
2:55 am, Sat Apr 20: Abidjan (GMT)
4:55 am, Sat Apr 20: Zagreb (CET)
10:55 pm, Fri Apr 19: Havana (CST)
5:55 am, Sat Apr 20: Nicosia (EET)
4:55 am, Sat Apr 20: Prague (CET)
4:55 am, Sat Apr 20: Copenhagen (CET)
5:55 am, Sat Apr 20: Djibouti (EAT)
10:55 pm, Fri Apr 19: Dominica (AST)
10:55 pm, Fri Apr 19: Santo Domingo (AST)
8:55 pm, Fri Apr 19: Galapagos (GALT)
9:55 pm, Fri Apr 19: Guayaquil (ECT)
4:55 am, Sat Apr 20: Cairo (EET)
8:55 pm, Fri Apr 19: El Salvador (CST)
3:55 am, Sat Apr 20: Malabo (WAT)
5:55 am, Sat Apr 20: Tallinn (EET)
5:55 am, Sat Apr 20: Addis Ababa (EAT)
10:55 pm, Fri Apr 19: Stanley (FKT)
2:55 pm, Sat Apr 20: Fiji (FJT)
5:55 am, Sat Apr 20: Helsinki (EET)
4:55 am, Sat Apr 20: Paris (CET)
11:55 pm, Fri Apr 19: Cayenne (GFT)
4:55 pm, Fri Apr 19: Tahiti (TAHT)
5:25 pm, Fri Apr 19: Marquesas (MART)
5:55 pm, Fri Apr 19: Gambier (GAMT)
7:55 am, Sat Apr 20: Kerguelen (TFT)
3:55 am, Sat Apr 20: Libreville (WAT)
2:55 am, Sat Apr 20: Banjul (GMT)
6:55 am, Sat Apr 20: Tbilisi (GET)
4:55 am, Sat Apr 20: Berlin (CET)
2:55 am, Sat Apr 20: Accra (GMT)
4:55 am, Sat Apr 20: Gibraltar (CET)
5:55 am, Sat Apr 20: Athens (EET)
11:55 pm, Fri Apr 19: Thule (AST)
12:55 am, Sat Apr 20: Godthab (WGT)
2:55 am, Sat Apr 20: Scoresbysund (EGT)
2:55 am, Sat Apr 20: Danmarkshavn (GMT)
10:55 pm, Fri Apr 19: Grenada (AST)
10:55 pm, Fri Apr 19: Guadeloupe (AST)
12:55 pm, Sat Apr 20: Guam (ChST)
8:55 pm, Fri Apr 19: Guatemala (CST)
2:55 am, Sat Apr 20: Conakry (GMT)
2:55 am, Sat Apr 20: Bissau (GMT)
10:55 pm, Fri Apr 19: Guyana (GYT)
10:55 pm, Fri Apr 19: Port-au-Prince (EST)
4:55 am, Sat Apr 20: Vatican (CET)
8:55 pm, Fri Apr 19: Tegucigalpa (CST)
10:55 am, Sat Apr 20: Hong Kong (HKT)
4:55 am, Sat Apr 20: Budapest (CET)
2:55 am, Sat Apr 20: Reykjavik (GMT)
9:55 am, Sat Apr 20: Jakarta (WIT)
9:55 am, Sat Apr 20: Pontianak (WIT)
11:55 am, Sat Apr 20: Jayapura (EIT)
6:25 am, Sat Apr 20: Tehran (IRT)
5:55 am, Sat Apr 20: Baghdad (AST)
3:55 am, Sat Apr 20: Dublin (GMT)
5:55 am, Sat Apr 20: Jerusalem (IST)
4:55 am, Sat Apr 20: Rome (CET)
9:55 pm, Fri Apr 19: Jamaica (EST)
11:55 am, Sat Apr 20: Tokyo (JST)
4:55 am, Sat Apr 20: Amman (EET)
6:55 am, Sat Apr 20: Aqtau (AQTT)
7:55 am, Sat Apr 20: Aqtobe (AQTT)
8:55 am, Sat Apr 20: Almaty (ALMT)
5:55 am, Sat Apr 20: Nairobi (EAT)
2:55 pm, Sat Apr 20: Tarawa (GILT)
3:55 pm, Sat Apr 20: Enderbury (PHOT)
4:55 pm, Sat Apr 20: Kiritimati (LINT)
11:55 am, Sat Apr 20: Pyongyang (KST)
11:55 am, Sat Apr 20: Seoul (KST)
5:55 am, Sat Apr 20: Kuwait (AST)
7:55 am, Sat Apr 20: Bishkek (KGT)
9:55 am, Sat Apr 20: Vientiane (ICT)
5:55 am, Sat Apr 20: Riga (EET)
5:55 am, Sat Apr 20: Beirut (EET)
4:55 am, Sat Apr 20: Maseru (SAST)
2:55 am, Sat Apr 20: Monrovia (GMT)
4:55 am, Sat Apr 20: Tripoli (EET)
4:55 am, Sat Apr 20: Vaduz (CET)
5:55 am, Sat Apr 20: Vilnius (EET)
4:55 am, Sat Apr 20: Luxembourg (CET)
4:55 am, Sat Apr 20: Skopje (CET)
5:55 am, Sat Apr 20: Antananarivo (EAT)
4:55 am, Sat Apr 20: Blantyre (CAT)
10:55 am, Sat Apr 20: Kuala Lumpur (MYT)
10:55 am, Sat Apr 20: Kuching (MYT)
7:55 am, Sat Apr 20: Maldives (MVT)
2:55 am, Sat Apr 20: Bamako (GMT)
4:55 am, Sat Apr 20: Malta (CET)
2:55 pm, Sat Apr 20: Kwajalein (MHT)
2:55 pm, Sat Apr 20: Majuro (MHT)
10:55 pm, Fri Apr 19: Martinique (AST)
2:55 am, Sat Apr 20: Nouakchott (GMT)
6:55 am, Sat Apr 20: Mauritius (MUT)
5:55 am, Sat Apr 20: Mayotte (EAT)
7:55 pm, Fri Apr 19: Chihuahua (MST)
7:55 pm, Fri Apr 19: Hermosillo (MST)
7:55 pm, Fri Apr 19: Mazatlan (MST)
7:55 pm, Fri Apr 19: Tijuana (PST)
8:55 pm, Fri Apr 19: Cancun (CST)
8:55 pm, Fri Apr 19: Merida (CST)
8:55 pm, Fri Apr 19: Mexico City (CST)
8:55 pm, Fri Apr 19: Monterrey (CST)
1:55 pm, Sat Apr 20: Kosrae (KOST)
5:55 am, Sat Apr 20: Chisinau (EET)
4:55 am, Sat Apr 20: Monaco (CET)
9:55 am, Sat Apr 20: Hovd (HOVT)
10:55 am, Sat Apr 20: Ulaanbaatar (ULAT)
11:55 am, Sat Apr 20: Choibalsan (CHOT)
10:55 pm, Fri Apr 19: Montserrat (AST)
3:55 am, Sat Apr 20: Casablanca (WET)
4:55 am, Sat Apr 20: Maputo (CAT)
9:25 am, Sat Apr 20: Rangoon (MMT)
3:55 am, Sat Apr 20: Windhoek (WAT)
2:55 pm, Sat Apr 20: Nauru (NRT)
4:55 am, Sat Apr 20: Amsterdam (CET)
1:55 pm, Sat Apr 20: Noumea (NCT)
2:55 pm, Sat Apr 20: Auckland (NZST)
3:40 pm, Sat Apr 20: Chatham (CHAST)
8:55 pm, Fri Apr 19: Managua (CST)
3:55 am, Sat Apr 20: Niamey (WAT)
3:55 am, Sat Apr 20: Lagos (WAT)
3:55 pm, Fri Apr 19: Niue (NUT)
2:25 pm, Sat Apr 20: Norfolk (NFT)
12:55 pm, Sat Apr 20: Saipan (ChST)
4:55 am, Sat Apr 20: Oslo (CET)
6:55 am, Sat Apr 20: Muscat (GST)
7:55 am, Sat Apr 20: Karachi (PKT)
11:55 am, Sat Apr 20: Palau (PWT)
5:55 am, Sat Apr 20: Gaza (EET)
9:55 pm, Fri Apr 19: Panama (EST)
12:55 pm, Sat Apr 20: Port Moresby (PGT)
10:55 pm, Fri Apr 19: Asuncion (PYT)
9:55 pm, Fri Apr 19: Lima (PET)
10:55 am, Sat Apr 20: Manila (PHT)
6:55 pm, Fri Apr 19: Pitcairn (PST)
4:55 am, Sat Apr 20: Warsaw (CET)
2:55 am, Sat Apr 20: Azores (AZOT)
3:55 am, Sat Apr 20: Madeira (WET)
3:55 am, Sat Apr 20: Lisbon (WET)
10:55 pm, Fri Apr 19: Puerto Rico (AST)
5:55 am, Sat Apr 20: Qatar (AST)
4:55 am, Sat Apr 20: Belgrade (CET)
6:55 am, Sat Apr 20: Reunion (RET)
5:55 am, Sat Apr 20: Bucharest (EET)
4:55 am, Sat Apr 20: Kaliningrad (EET)
5:55 am, Sat Apr 20: Moscow (MSK)
6:55 am, Sat Apr 20: Samara (SAMT)
7:55 am, Sat Apr 20: Yekaterinburg (YEKT)
8:55 am, Sat Apr 20: Novosibirsk (NOVT)
8:55 am, Sat Apr 20: Omsk (OMST)
9:55 am, Sat Apr 20: Krasnoyarsk (KRAT)
10:55 am, Sat Apr 20: Irkutsk (IRKT)
11:55 am, Sat Apr 20: Yakutsk (YAKT)
12:55 pm, Sat Apr 20: Sakhalin (SAKT)
12:55 pm, Sat Apr 20: Vladivostok (VLAT)
1:55 pm, Sat Apr 20: Magadan (MAGT)
2:55 pm, Sat Apr 20: Anadyr (ANAT)
2:55 pm, Sat Apr 20: Kamchatka (PETT)
4:55 am, Sat Apr 20: Kigali (CAT)
2:55 am, Sat Apr 20: St Helena (GMT)
10:55 pm, Fri Apr 19: St Kitts (AST)
10:55 pm, Fri Apr 19: St Lucia (AST)
12:55 am, Sat Apr 20: Miquelon (PMST)
10:55 pm, Fri Apr 19: St Vincent (AST)
3:55 pm, Fri Apr 19: Apia (WST)
4:55 am, Sat Apr 20: San Marino (CET)
2:55 am, Sat Apr 20: Sao Tome (GMT)
5:55 am, Sat Apr 20: Riyadh (AST)
2:55 am, Sat Apr 20: Dakar (GMT)
6:55 am, Sat Apr 20: Mahe (SCT)
2:55 am, Sat Apr 20: Freetown (GMT)
10:55 am, Sat Apr 20: Singapore (SGT)
4:55 am, Sat Apr 20: Bratislava (CET)
4:55 am, Sat Apr 20: Ljubljana (CET)
1:55 pm, Sat Apr 20: Guadalcanal (SBT)
5:55 am, Sat Apr 20: Mogadishu (EAT)
4:55 am, Sat Apr 20: Johannesburg (SAST)
12:55 am, Sat Apr 20: South Georgia (GST)
3:55 am, Sat Apr 20: Canary (WET)
4:55 am, Sat Apr 20: Ceuta (CET)
4:55 am, Sat Apr 20: Madrid (CET)
8:55 am, Sat Apr 20: Colombo (LKT)
5:55 am, Sat Apr 20: Khartoum (EAT)
11:55 pm, Fri Apr 19: Paramaribo (SRT)
4:55 am, Sat Apr 20: Arctic - Longyearbyen (CET)
4:55 am, Sat Apr 20: Mbabane (SAST)
4:55 am, Sat Apr 20: Stockholm (CET)
4:55 am, Sat Apr 20: Zurich (CET)
4:55 am, Sat Apr 20: Damascus (EET)
10:55 am, Sat Apr 20: Taipei (CST)
7:55 am, Sat Apr 20: Dushanbe (TJT)
5:55 am, Sat Apr 20: Dar es Salaam (EAT)
9:55 am, Sat Apr 20: Bangkok (ICT)
11:55 am, Sat Apr 20: Dili (TPT)
2:55 am, Sat Apr 20: Lome (GMT)
4:55 pm, Fri Apr 19: Fakaofo (TKT)
3:55 pm, Sat Apr 20: Tongatapu (TOT)
10:55 pm, Fri Apr 19: Port of Spain (AST)
3:55 am, Sat Apr 20: Tunis (CET)
4:55 am, Sat Apr 20: Istanbul (EET)
7:55 am, Sat Apr 20: Ashgabat (TMT)
10:55 pm, Fri Apr 19: Grand Turk (EST)
2:55 pm, Sat Apr 20: Funafuti (TVT)
5:55 am, Sat Apr 20: Kampala (EAT)
4:55 am, Sat Apr 20: Simferopol (EET)
5:55 am, Sat Apr 20: Kiev (EET)
5:55 am, Sat Apr 20: Uzhgorod (EET)
5:55 am, Sat Apr 20: Zaporozhye (EET)
6:55 am, Sat Apr 20: Dubai (GST)
3:55 am, Sat Apr 20: London (GMT)
4:55 pm, Fri Apr 19: Honolulu (HST)
5:55 pm, Fri Apr 19: Adak (HAST)
6:55 pm, Fri Apr 19: Anchorage (AKST)
6:55 pm, Fri Apr 19: Juneau (AKST)
6:55 pm, Fri Apr 19: Nome (AKST)
6:55 pm, Fri Apr 19: Yakutat (AKST)
7:55 pm, Fri Apr 19: Phoenix (MST)
7:55 pm, Fri Apr 19: Los Angeles (PST)
8:55 pm, Fri Apr 19: Boise (MST)
8:55 pm, Fri Apr 19: Denver (MST)
8:55 pm, Fri Apr 19: Shiprock (MST)
9:55 pm, Fri Apr 19: Chicago (CST)
9:55 pm, Fri Apr 19: Indiana - Knox (CST)
9:55 pm, Fri Apr 19: Menominee (CST)
9:55 pm, Fri Apr 19: North Dakota - Center (CST)
10:55 pm, Fri Apr 19: Detroit (EST)
10:55 pm, Fri Apr 19: Indiana - Indianapolis (EST)
10:55 pm, Fri Apr 19: Indiana - Marengo (EST)
10:55 pm, Fri Apr 19: Indiana - Vevay (EST)
10:55 pm, Fri Apr 19: Kentucky - Louisville (EST)
10:55 pm, Fri Apr 19: Kentucky - Monticello (EST)
10:55 pm, Fri Apr 19: New York (EST)
3:55 pm, Fri Apr 19: Midway (SST)
4:55 pm, Fri Apr 19: Johnston (HST)
2:55 pm, Sat Apr 20: Wake (WAKT)
11:55 pm, Fri Apr 19: Montevideo (UYT)
7:55 am, Sat Apr 20: Samarkand (TMT)
7:55 am, Sat Apr 20: Tashkent (UZT)
1:55 pm, Sat Apr 20: Efate (VUT)
10:55 pm, Fri Apr 19: Caracas (VET)
10:55 pm, Fri Apr 19: Tortola (AST)
10:55 pm, Fri Apr 19: St Thomas (AST)
2:55 pm, Sat Apr 20: Wallis (WFT)
3:55 am, Sat Apr 20: El Aaiun (WET)
5:55 am, Sat Apr 20: Aden (AST)
4:55 am, Sat Apr 20: Lusaka (CAT)
4:55 am, Sat Apr 20: Harare (CAT)
PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT
Welcome to Kara Daugherty Counseling. This document (the Agreement)
contains important information about my professional services and
business policies. It also contains summary information about the
Health Insurance Portability and Accountability Act (HIPAA), a new
federal law that provides new privacy protections and new patient
rights with regard to the use and disclosure of your Protected
Health Information (PHI) used for the purpose of treatment,
payment, and health care operations. HIPAA requires that I provide
you with a Notice of Privacy Practices (the Notice) for use and
disclosure of PHI for treatment, payment and health care
operations. The Notice, which is attached to this Agreement,
explains HIPAA and its application to your personal health
information in greater detail. The law requires that I obtain your
signature acknowledging that I have provided you with this
information at the end of this session. Although these documents
are long and sometimes complex, it is very important that you read
them carefully before our next session. We can discuss any
questions you have about the procedures at that time. When you sign
this document, it will also represent an agreement between us. You
may revoke this Agreement in writing at any time. That revocation
will be binding on me unless I have taken action in reliance on it;
if there are obligations imposed on me by your health insurer in
order to process or substantiate claims made under your policy; or
if you have not satisfied any financial obligations you have
incurred.
PSYCHOLOGICAL / COUNSELING SERVICES
Psychotherapy is not easily described in general statements. It
varies depending on the personalities of the psychologist and
patient, and the particular problems you are experiencing. There
are many different methods I may use to deal with the problems that
you hope to address. Psychotherapy is not like a medical doctor
visit. Instead, it calls for a very active effort on your part. In
order for the therapy to be most successful, you will have to work
on things we talk about both during our sessions and at home.
Psychotherapy can have benefits and risks. Since therapy often
involves discussing unpleasant aspects of your life, you may
experience uncomfortable feelings like sadness, guilt, anger,
frustration, loneliness, and helplessness. On the other hand,
psychotherapy has also been shown to have many benefits. Therapy
often leads to better relationships, solutions to specific
problems, and significant reductions in feelings of distress. But
there are no guarantees of what you will experience.
Our first few sessions will involve an evaluation of your needs. By
the end of the evaluation, I will be able to offer you some first
impressions of what our work will include and a treatment plan to
follow, if you decide to continue with therapy. You should evaluate
this information along with your own opinions of whether you feel
comfortable working with me. Therapy involves a large commitment of
time, money, and energy, so you should be very careful about the
therapist you select. If you have questions about my procedures, we
should discuss them whenever they arise. If your doubts persist, I
will be happy to help you set up a meeting with another mental
health professional for a second opinion.
MEETINGS
I normally conduct an evaluation during the initial session. During
this time, we can both decide if I am the best person to provide
the services you need in order to meet your treatment goals. If
psychotherapy is begun, I will usually schedule one session weekly
or biweekly at a time we agree on, although some sessions may be
more frequent. Length of sessions are typically 52 minutes,
depending upon the presenting issues and availability in my
schedule. We are able to do extended session based on therapeutic
need.
Once an appointment hour is scheduled, you will be expected to pay
for it unless you provide 48 hours advance notice of cancellation
(or unless we both agree that you were unable to attend due to
circumstances beyond your control). It is important to note that
insurance companies do not provide reimbursement for cancelled
sessions. The rate for a missed appointment is $130 . If it is
possible, I will try to find another time to reschedule the
appointment.
PROFESSIONAL FEES
My fee for intake evaluations is $185.00; the fee follow-up
appointments (52 -minutes) is $130. In addition to follow-up
appointments, phone calls, letter composition, extensive email
contact with client, family or other professionals will be billed
at $25 / 15 minutes. Kara Daugherty Counseling charges the full fee
for each missed appointment which is not cancelled at least 24
hours in advance. In some instances further appointments will not
be scheduled until the no-show fee is paid in full. Please be aware
than your insurance will not pay for missed appointment fees.
CONTACTING ME
Due to my work schedule, I am often not immediately available by
telephone. I will not answer the phone when I am with a patient.
When I am unavailable, my telephone is answered by voice mail. I
will make every effort to return your call on the same day, with
the exception of weekends and holidays. If you are difficult to
reach, please inform me of some times when you will be available.
If you are unable to reach me and feel that you can't wait for me
to return your call, contact your family physician or the nearest
emergency room and ask for the counselor or psychiatrist on call.
If I will be unavailable for an extended time, I will provide you
with the name of a colleague to contact, if necessary. Email is an
option to address simple issues such as scheduling. Please see our
"Social Media Policy" for additional information regarding online
contacts.
EMERGENCY PROCEDURES: If you are experiencing a crisis and you are
unable to reach me directly please go to the nearest emergency room
or call 911. Please do not use e-mail or faxes for emergencies.
I do not always check e-mail daily.
LIMITS ON CONFIDENTIALITY
The law protects the privacy of all communications between a
patient and a counselor. In most situations, I can only release
information about your treatment to others if you sign a written
Authorization form that meets certain legal requirements imposed by
HIPAA and/or Indiana law. However, in the following situations, no
authorization is required:
I may occasionally find it helpful to consult other health and
mental health professionals about a case. During a consultation, I
make every effort to avoid revealing the identity of my patient.
The other professionals are also legally bound to keep the
information confidential. If you don't object, I will not tell you
about these consultations unless I feel that it is important to our
work together. I will note all consultations in your Clinical
Record (which is called "PHI" in my Notice of Policies and
Practices to Protect the Privacy of Your Health Information).
You should be aware that I may employ administrative staff. In most
cases, I need to share protected information with these individuals
for both clinical and administrative purposes, such as scheduling,
billing and quality assurance. All staff members have been given
training about protecting your privacy and have agreed not to
release any information outside of the practice without the
permission of a professional staff member.
Disclosures required by health insurers or to collect overdue fees
are discussed elsewhere in this Agreement.
If you are involved in a court proceeding and a request is made for
information concerning the professional services I provided to you,
such information is protected by the counselor-patient privilege
law. I cannot provide any information without your (or your legal
representative's) written authorization, or a court order. If you
are involved in or contemplating litigation, you should consult
with your attorney to determine whether a court would be likely to
order me to disclose information.
Other reasons for disclosure of information may include: (1) If a
government agency is requesting the information for health
oversight activities, I may be required to provide it for them (2)
To a coroner or medical examiner, in the performance of that
individual's duties (3) If a patient files a complaint or lawsuit
against me, I may disclose relevant information regarding that
patient in order to defend myself.
There are some situations in which I am legally obligated to take
actions, which I believe are necessary to attempt to protect others
from harm. In these cases I may have to reveal some information
about a patient's treatment. These situations are unusual in my
practice, and would include:
If I have reason to believe that a child is a victim of child abuse
or neglect, the law requires that I file a report with the
appropriate government agency, usually the local child protection
service. Once such a report is filed, I may be required to provide
additional information.
If I have reason to believe that someone is an endangered adult,
the law requires that I file a report with the appropriate
government agency, usually the adult protective services unit. Once
such a report is filed, I may be required to provide additional
information.
If a patient communicates an actual threat of physical violence
against an identifiable victim, or evidences conduct or makes
statements indicating imminent danger that the patient will use
physical violence or other means to cause serious personal injury
to others, I may be required to disclose information in order to
take protective actions. These actions may include notifying the
potential victim, contacting the police, or seeking hospitalization
for the patient.
If a patient communicates an imminent threat of serious physical
harm to him/herself, I may be required to disclose information in
order to take protective actions. These actions may include
initiating hospitalization or contacting family members or others
who can assist in providing protection.
If such a situation arises, I will make every effort to fully
discuss it with you before taking any action and I will limit my
disclosure to what is necessary.
While this written summary of exceptions to confidentiality should
prove helpful in informing you about potential problems, it is
important that we discuss any questions or concerns that you may
have now or in the future. The laws governing confidentiality can
be quite complex, and I am not an attorney. In situations where
specific advice is required, formal legal advice may be needed.
PROFESSIONAL RECORDS
You should be aware that, pursuant to HIPAA, I keep Protected
Health Information about you in two sets of professional records.
One set constitutes your Clinical Record. It includes information
about your reasons for seeking therapy, a description of the ways
in which your problem impacts on your life, your diagnosis, the
goals that we set for treatment, your progress towards those goals,
your medical and social history, your treatment history, any past
treatment records that I receive from other providers, reports of
any professional consultations, your billing records, and any
reports that have been sent to anyone, including reports to your
insurance carrier. Except in unusual circumstances that involve
danger to yourself and others, you may examine and/or receive a
copy of your Clinical Record, if you request it in writing. Because
these are professional records, they can be misinterpreted and/or
upsetting to untrained readers. For this reason, I recommend that
you initially review them in my presence, or have them forwarded to
another mental health professional so you can discuss the contents.
I am sometimes willing to conduct this review meeting without
charge. In most circumstances, I am allowed to charge a copying fee
of $1.00 per page (and for certain other expenses). If I refuse
your request for access to your Clinical Records, you have a right
of review, which I will discuss with you upon request.
In addition, I also keep a set of Psychotherapy Notes. These Notes
are for my own use and are designed to assist me in providing you
with the best treatment. While the contents of Psychotherapy Notes
vary from client to client, they can include the contents of our
conversations, my analysis of those conversations, and how they
impact on your therapy. They also contain particularly sensitive
information that you may reveal to me that is not required to be
included in your Clinical Record. (They also include information
from others provided to me confidentially.) These Psychotherapy
Notes are kept separate from your Clinical Record. Your
Psychotherapy Notes are not available to you and cannot be sent to
anyone else, including insurance companies without your written,
signed Authorization. Insurance companies cannot require your
authorization as a condition of coverage nor penalize you in any
way for your refusal to provide it.
PATIENT RIGHTS
HIPAA provides you with several new or expanded rights with regard
to your Clinical Records and disclosures of protected health
information. These rights include requesting that I amend your
record; requesting restrictions on what information from your
Clinical Records is disclosed to others; requesting an accounting
of most disclosures of protected health information that you have
neither consented to nor authorized; determining the location to
which protected information disclosures are sent; having any
complaints you make about my policies and procedures recorded in
your records; and the right to a paper copy of this Agreement, the
attached Notice form, and my privacy policies and procedures. I am
happy to discuss any of these rights with you.
MINORS & PARENTS
Patients under 18 years of age who are not emancipated and their
parents should be aware that the law may allow parents to examine
their child's treatment records. Because privacy in psychotherapy
is often crucial to successful progress, particularly with
teenagers, it is sometimes my policy to request an agreement from
parents that they consent to give up their access to their child's
records. If they agree, during treatment, I will provide them only
with general information about the progress of the child's
treatment, and his/her attendance at scheduled sessions. I will
also provide parents with a summary of their child's treatment when
it is complete. Any other communication will require the child's
Authorization, unless I feel that the child is in danger or is a
danger to someone else, in which case, I will notify the parents of
my concern. Before giving parents any information, I will discuss
the matter with the child, if possible, and do my best to handle
any objections he/she may have.
LITIGATION LIMITATION
Due to the nature of the therapeutic process and the fact that it
often involves making a full disclosure with regard to many matters
which may be of a confidential nature, it is agreed that, should
there be legal proceedings (such as, but not limited to divorce and
custody disputes, injuries, lawsuits, etc.), neither you nor your
attorney(s), nor anyone else acting on your behalf will call on
Kara Daugherty to testify in court or at any other proceeding, nor
will a disclosure of the psychotherapy records be requested unless
otherwise agreed upon.
BILLING AND PAYMENTS
You will be expected to pay for each session at the time it is
held, unless we agree otherwise or unless you have insurance
coverage that requires another arrangement. Payment schedules for
other professional services will be agreed to when they are
requested. In circumstances of unusual financial hardship, I may be
willing to negotiate a fee adjustment or payment installment
plan.
If your account has not been paid for more than 60 days and
arrangements for payment have not been agreed upon, I have the
option of using legal means to secure the payment. This may involve
hiring a collection agency or going through small claims court
which will require me to disclose otherwise confidential
information. In most collection situations, the only information I
release regarding a patient's treatment is his/her name, the nature
of services provided, contact information on file and the amount
due. If such legal action is necessary, its costs will be included
in the claim.
INSURANCE REIMBURSEMENT
In order for us to set realistic treatment goals and priorities, it
is important to evaluate what resources you have available to pay
for your treatment. If you have a health insurance policy, it will
usually provide some coverage for mental health treatment. I will
provide you with whatever assistance I can in helping you receive
the benefits to which you are entitled; however, you (not your
insurance company) are responsible for full payment of my fees. It
is very important that you find out exactly what mental health
services your insurance policy covers and obtain any necessary
authorizations prior to your session.
You should carefully read the section in your insurance coverage
booklet that describes mental health services. If you have
questions about the coverage, call your plan administrator. Of
course, I will provide you with whatever information I can based on
my experience and will be happy to help you in understanding the
information you receive from your insurance company. If it is
necessary to clear confusion, I will be willing to call the company
on your behalf.
Due to the rising costs of health care, insurance benefits have
increasingly become more complex. It is sometimes difficult to
determine exactly how much mental health coverage is available.
"Managed Health Care" plans such as HMOs and PPOs often require
authorization before they provide reimbursement for mental health
services. These plans are often limited to short-term treatment
approaches designed to work out specific problems that interfere
with a person's usual level of functioning. It may be necessary to
seek approval for more therapy after a certain number of sessions.
While much can be accomplished in short-term therapy, some patients
feel that they need more services after insurance benefits end.
Some managed-care plans will not allow me to provide services to
you once your benefits end. If this is the case, I will do my best
to find another provider who will help you continue your
psychotherapy.
You should also be aware that your contract with your health
insurance company requires that I provide it with information
relevant to the services that I provide to you. I am required to
provide a clinical diagnosis. Sometimes I am required to provide
additional clinical information such as treatment plans or
summaries, or copies of your entire Clinical Record. In such
situations, I will make every effort to release only the minimum
information about you that is necessary for the purpose requested.
This information will become part of the insurance company files
and will probably be stored in a computer. Though all insurance
companies claim to keep such information confidential, I have no
control over what they do with it once it is in their hands. In
some cases, they may share the information with a national medical
information databank. I will provide you with a copy of any report
I submit, if you request it.
You should understand that the information used or disclosed to
your insurance may be subject to re-disclosure and no longer
protected under law. It is not required that you sign authorization
for this. Refusal will not negatively affect your ability to
receive mental health treatment from Kara Daugherty Counseling. If
you do not sign it, your health insurance will not be billed and
you will be required to pay with Cash, Check, or Credit / Debit
Card at the regular rate. You may revoke such authorization at any
time in writing. At that point, the information may no longer be
disclosed to your insurance carrier. Any use or disclosure already
made cannot be undone. To revoke this authorization, please request
the form to do so and return it to Kara Daugherty Counseling. This
written authorization is subject to revocation by the undersigned
at any time, except to the extent that action has been taken. This
authorization will expire 12 months from the signed date or a date
determined by you to be put in writing and giving to this
office.
You understand that you authorize the release of any medical or
other information necessary to process this claim. You also request
payment of government benefits either to yourself or to the party
who accepts assignment below. I authorize payment of medical
benefits to the undersigned Physician / Provider or supplier for
services described within this agreement.
Once we have all of the information about your insurance coverage,
we will discuss what we can expect to accomplish with the benefits
that are available and what will happen if they run out before you
feel ready to end your sessions. It is important to remember that
you always have the right to pay for my services yourself to avoid
the problems described above, unless prohibited by contract.
My signature below indicates I have the read and agree to
psychotherapist-client services agreement form and have no
questions.