NH Mental Health Bill of Rights
This Mental Health Bill of Rights is provided by law to persons receiving mental health services in the State of New Hampshire. Its purpose is to protect the rights and enhance the well being of clients, by informing them of key aspects of the clinical relationship. As a client of a New Hampshire Mental Health Practitioner, you have, without asking, the right:
(1) To be treated in a professional, respectful, competent, and ethical manner consistent with all applicable state laws and the following professional ethical standards:
a. For independent clinical social workers; the National Association of Social Workers;
b. For pastoral psychotherapists; the NH Association of Pastoral Psychotherapists;
c. For clinical mental health counselors; the American Mental Health Counselors Association; and
d. For marriage and family therapists; the American Association for Marriage and Family Therapists.
(2) To receive full information about your treatment provider’s knowledge, skills, experience and credentials.
(3) To have the information you disclose to your mental health provider kept confidential within the limits of state and federal law. Communications between mental health providers and clients are typically confidential, unless the law requires their disclosure. Mental health providers will inform you of the legal exceptions to confidentiality, and should such an exception arise, will share only such information as required by law. Examples of such exceptions include but are not limited to:
a. Abuse of a child;
b. Abuse of an incapacitated adult;
c. Health Information Portability and Accountability Act (HIPAA) regulation compliance;
d. Certain rights you may have waived when contracting for third party financial coverage;
e. Orders of the court; and
f. Significant threats to self, others or property.
(4) To a safe setting and to know that the services provided are effective and of a quality consistent with the standard of care within each profession and to know that sexual relations between a mental health provider and a client or former client are a violation of the law (RSA 330-A:36).
(5) To obtain information, as allowed by law, pertaining to the mental health provider’s assessment, assessment procedures and mental health diagnoses (RSA 330-A:2 VI).
(6) To participate meaningfully in the planning, implementation, and termination or referral of your treatment.
(7) To document informed consent: to be informed of the risks and benefits of the proposed treatment, the risks and benefits of alternative treatments, and the risks and benefits of no treatment. When obtaining informed consent for treatment for which safety and effectiveness have not been established, therapists will inform their clients of this and of the voluntary nature of their participation. In addition, clients have the right to be informed of their rights and responsibilities, and of the mental health provider’s practice policies regarding confidentiality, office hours, fees, missed appointments, billing policies, electronic communications, managed care issues, record management, and other relevant matters except as otherwise provided by law.
(8) To obtain information regarding the provision(s) for emergency coverage.
(9) To receive a copy of your mental health record within 30 days upon written request (except as otherwise provided by law), by paying a nominal fee designed to defray the administrative costs of reproducing the record.
(10) To know that your mental health provider is licensed by the State of New Hampshire to provide mental health services.
a. You have the right to obtain information about mental health practice in New Hampshire. You may contact the Board of Mental Health Practice for a list names, addresses, phone numbers and websites of state and national professional associations listed in Mhp 502.02(a)(1)a.
b. You have the right to discuss questions or concerns about the mental health services you receive with your provider.
c. You have the right to file a complaint with the Board of Mental Health Practice.
Massachusetts Client Bill of Rights
This Client Bill of Rights has been prepared by AsterRoot Wellness PLLC in accordance with applicable Massachusetts laws, regulations, and professional standards governing outpatient mental health counseling. It is not a state-issued document.
Outpatient Mental Health Services
AsterRoot Wellness PLLC is committed to providing professional, ethical, respectful, and clinically appropriate mental health services. Clients receiving outpatient mental health counseling have rights regarding their care, privacy, participation in treatment, and relationship with their clinician.
This Client Bill of Rights is provided in accordance with applicable Massachusetts law and professional standards, including 262 CMR 8.00 governing Licensed Mental Health Counselors.
Your Rights as a Client
As a client receiving mental health counseling services, you have the right to:
1. Respectful and Professional Treatment
Be treated with dignity, respect, compassion, and professional consideration throughout your care.
Receive services without discrimination based on race, color, religion, national origin, ancestry, sex, gender identity or expression, sexual orientation, age, disability, marital or family status, or other status protected by applicable law.
2. Informed Consent
Receive sufficient information about counseling services to make informed decisions regarding your care.
Before beginning treatment, you have the right to receive information regarding your clinician's credentials, the nature and purpose of services, relevant risks and benefits of counseling, confidentiality and its limitations, fees and billing practices, and policies related to telehealth, technology, and electronic communication when applicable.
You have the right to ask questions about any aspect of your treatment and to receive information necessary to make informed decisions regarding your care.
3. Participation in Treatment
Participate actively in decisions regarding your treatment, including the development and review of treatment goals.
You may ask questions about your diagnosis, treatment recommendations, therapeutic approaches, or other aspects of your care.
You may discuss concerns regarding treatment and request consideration of alternative approaches or referrals when clinically appropriate.
4. Privacy and Confidentiality
Have information obtained in the course of treatment treated as confidential in accordance with applicable federal and Massachusetts law.
Information about your treatment generally will not be released to another person or organization without your written authorization except when disclosure is permitted or required by law.
You have the right to receive information explaining confidentiality and its legal limits and exceptions.
Your clinician may obtain professional consultation or supervision when clinically appropriate. When consultation occurs, reasonable efforts will be made to protect your identity and privacy in accordance with applicable professional and legal requirements.
5. Treatment Records
Be informed that a clinical treatment record will be maintained regarding the services you receive.
You may request access to or copies of your treatment records as permitted by applicable state and federal law. Certain limitations or procedures may apply to requests for records.
AsterRoot Wellness PLLC maintains and protects clinical records in accordance with applicable legal and professional requirements.
6. Professional Boundaries
Receive services within an appropriate professional therapeutic relationship.
Your clinician is responsible for maintaining appropriate professional boundaries and avoiding relationships or conduct that would exploit the therapeutic relationship or interfere with professional judgment.
7. Information About Fees and Billing
Receive clear information regarding fees, billing procedures, insurance participation when applicable, cancellation policies, and your financial responsibilities for services.
You have the right to ask questions regarding charges associated with your care.
8. Choice and Termination of Treatment
You have the right to discontinue or terminate counseling at any time.
You may request a referral to another provider or seek a second opinion or alternative treatment provider.
When clinically appropriate, your clinician may recommend referral or transfer of care when your needs would be better served by another provider or level of care.
AsterRoot Wellness PLLC will make reasonable efforts to avoid abandonment and to facilitate an appropriate transition of care when referral or termination is clinically indicated.
9. Questions, Concerns, and Grievances
You have the right to raise questions, concerns, or complaints regarding your care without retaliation or interference with your rights.
Whenever possible, clients are encouraged to discuss concerns directly with their treating clinician so that concerns may be understood and addressed.
If you do not feel comfortable discussing a concern with your clinician, if the concern is not satisfactorily resolved, or if you prefer to pursue an external complaint, you may contact the:
Massachusetts Board of Registration of Allied Mental Health and Human Services Professions
250 Washington Street
Boston, MA 02108
Phone: (617) 624-6199
Information regarding the Board, professional licensing, and the complaint process is available through the Commonwealth of Massachusetts at Mass.gov.
Nothing in AsterRoot Wellness PLLC's internal grievance process prevents or limits your right to contact the appropriate licensing or regulatory authority.
10. Emergency and Crisis Services
AsterRoot Wellness PLLC provides outpatient mental health services and is not an emergency or crisis-response service.
If you are experiencing an immediate or life-threatening emergency, call 911 or go to the nearest emergency department. If you are experiencing a mental health or suicide-related crisis, you may also call or text 988 to reach the Suicide & Crisis Lifeline.
Summary of the Rights of Recipients of Mental Health Services
Community Based Services
This is a summary of your rights as a recipient of community based services under the Rights of Recipients of Mental Health Services. You have a right to obtain a full copy of the rights from this agency or from the Department of Health and Human Services, Office of Behavioral Health, 11 State House Station-41 Anthony Ave., Augusta, Maine 04330, Tel # (207) 287-2595, TTY Users: Dial 711 (Maine Relay). If you are deaf or do not understand English, an interpreter will be made available to you so that you can understand your rights.
1. Basic Rights:
You have the same civil, human, and legal rights which all citizens have. You have a right to be treated with courtesy and full respect for your individuality and dignity.
2. Confidentiality and Access to Records:
You have the right to have your records kept confidential and only released with your full informed consent. You have the right to review your record at any reasonable time. You may add written comments to your record to clarify information you believe is inaccurate or incomplete. No one else can see your record unless you specifically authorize them to see it, except in instances described in the complete rights book.
3. Individualized Treatment or Service Plan: You have the right to an individualized plan, developed by you and your worker, based upon your needs and goals. The plan must be in writing and you have the right to a copy. The plan needs to specifically detail what everyone will do, the time frames in which the tasks and goals will be accomplished and how success will be determined. The plan must be based upon your actual needs and, if a needed service is not available, detail how your need will be met.
4. Informed Consent: No services or treatment can be provided to you against your will. If you have a guardian, he or she is authorized to make decisions without your consent. You have the right to be informed of the possible risks and anticipated benefits of all services and treatment, including medications, in a manner which you understand. If you have any questions, you may ask your worker or anyone else you choose before making decisions about treatment or services. If a guardian has been authorized to make decisions for you, the guardian has the right to be fully informed of all risks and benefits or proposed treatment or services.
5. Assistance in the Protection of Rights: You have the right to appoint a representative of your choice to help you understand your rights, protect your rights or help you work out a treatment or service plan. If you wish a representative, you must designate this person in writing. You can have access to the representative at any time you wish and you can change or cancel the designation at any time.
6. Freedom from Seclusion and Restraint. You cannot be secluded or restrained in the community setting.
7. Right to File a Grievance. You have the right to bring a grievance to challenge any possible violation of your rights or any questionable practices. You have the right to have your grievance answered in writing, with reasons for the decisions. You may appeal any decision to the Office of Behavioral Health. You may not be punished in any way for filing a grievance. You cannot be retaliated against for filing a grievance. For help with filing a grievance, contact OBH Grievance Coordinator, (207) 287-2595, TTY Users: Dial 711 (Maine Relay), 11 State House Station-41 Anthony Avenue, Augusta, Maine 04333, or call Disability Rights Maine, 160 Capitol St #4, Augusta, ME 04330, Tel # 1-800-452-1948 (V/TTY).
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.
Your Rights
You have the right to:
Get a copy of your paper or electronic medical record
Correct your paper or electronic medical record
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
Tell family and friends about your condition
Provide disaster relief
Include you in a hospital directory
Provide mental health care
Market our services and sell your information
Raise funds
Our Uses and Disclosures
We may use and share your information as we:
Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on page 1.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care or payment for your care
Share information in a disaster relief situation
Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Marketing purposes
Sale of your information
Most sharing of psychotherapy notes
In the case of fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again.
If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
Help with public health and safety issues
We can share health information about you for certain situations such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Effective Date of this Notice: 01/2025
Privacy Officer:
Ashley Raymond, LCMHC, PMH-C
Alternate Privacy Contact:
Carin Romero, LICSW, PMH-C
AsterRoot Wellness PLLC
Phone: (603) 314-3040
Alternate Phone: (818) 851-7307
Email: AsterRootWellness@outlook.com
Secondary Email: Carin-asterrw@outlook.com
We never market or sell personal information. We will not share your mental health treatment records without your written consent unless it is for treatment or another law requires us to share the information.
At AsterRoot Wellness PLLC, health information is stored via the online Headway portal.To request medical or clinical records, contact your specific healthcare provider directly, as Headway refers clients back to their treating clinician for clinical records. For official privacy rights requests or general data inquiries, you can reach out via Headway's official privacy and support channels: https://help.headway.co/hc/en-us/articles/4740211050516-Contacting-Headway-support#h_01FXZXNDSMG0DF07MBYSZCR66P