Patient Consents & Policies

Notice of Privacy Practices (HIPAA)

IShine Behavioral Health, Inc. (“IShine”) is committed to protecting your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

By providing consent, you acknowledge that:

  • You have received, read, and understood IShine’s Privacy Policy.
  • You understand how your PHI may be used or disclosed for treatment, payment, or healthcare operations.
  • You understand your rights to:
    • Inspect and obtain a copy of your PHI
    • Request corrections to your PHI
    • Request restrictions on certain uses and disclosures
    • Receive confidential communications

Consent for Treatment

You voluntarily consent to receive mental and behavioral health services from IShine, including:

  • Initial assessments and ongoing therapy
  • Psychological or behavioral health interventions
  • Consultations, case management, and coordination with other providers

By consenting, you understand that:

  • Treatment is voluntary and you may withdraw consent at any time.
  • IShine may provide care recommendations based on clinical judgment.
  • There may be risks, benefits, and alternatives to treatment, which will be explained by your provider.

Telehealth Services Consent

If telehealth services are used (via video, phone, or secure messaging):

  • You consent to telehealth services and understand the technical limitations and risks, including possible interruptions or breaches of confidentiality.
  • Telehealth may not be a complete substitute for in-person care.
  • In case of urgent mental health crises during telehealth sessions, IShine may contact local emergency services or your emergency contact.

Use of AI for Clinical Documentation

I understand that neither I nor my provider will record online sessions for personal use. To ensure accurate and high-quality clinical documentation, my provider may use a secure, HIPAA-compliant service that temporarily captures session audio and uses AI-assisted technology to automatically generate clinical notes.

  • This process is strictly for documentation purposes.
  • No audio recordings are stored or shared outside the secure system.
  • All information is handled confidentially in compliance with HIPAA and other privacy laws.
  • This technology is used to enhance the accuracy and quality of care.

Authorization for Use and Disclosure of PHI

By providing consent, you authorize IShine to use or disclose your PHI for:

  • Treatment: coordinating care with other health providers.
  • Payment: submitting claims and verifying insurance coverage.
  • Healthcare operations: quality assurance, audits, and internal administrative purposes.

You understand that:

  • You may revoke this authorization at any time in writing, except where action has already been taken.
  • PHI may only be released to specified entities for the purposes outlined above.

Communication Consent

You consent to receive communications from IShine via phone, email, and text messages for appointment reminders, billing information, or clinical updates. Standard text messaging and email may not be fully encrypted; by providing consent, you accept the privacy risks of electronic communication.

Emergency & Confidentiality Policies

While IShine protects your confidentiality, certain situations require mandatory disclosure:

  • Risk of serious harm to self or others
  • Abuse or neglect of children, elders, or vulnerable adults
  • Court orders, subpoenas, or other legal requirements

In these cases, IShine may contact emergency services, law enforcement, or the patient’s guardian.

Financial & Insurance Acknowledgment

  • Agree to assign benefits to IShine for payment of services.
  • Understand your financial responsibility for services not covered by insurance.
  • Have received or been offered a Good Faith Estimate of charges if self-paying.
  • Understand late payment and collection policies.

Guardian / Minor Acknowledgment (If Applicable)

  • Parent or legal guardian must provide documentation of guardianship rights.
  • Guardian acknowledges responsibility for treatment consent and financial obligations.
  • Guardian’s acknowledgment is required where applicable.

Review & Acknowledgment

By proceeding with services, you acknowledge that you have read and understood all sections above and agree to comply with the policies described.