Parakalein Counseling & Consultation Services

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Patient Information and Staff Procedures

Information concerning patients is highly confidential.  This includes all information concerning patients, such as medical conditions, social and personal history, and financial situation.  Employees are expected to guard the privacy of patients by doing the following:

  • Keeping all patient-related information secure, including items such as patient records, referral forms, billing records, medical reports, and appointment schedules.  Such items are kept out of the sight of patients and staff.
  • Forwarding all requests for patient information whether from the patient’s family, another physician, an insurer, or a lawyer, directly to Dr. Paine. No information will ever be released without the written consent of the patient.
  • Refraining from looking at patient's records unless it is essential to the performance of job functions.
  • Not discussing any aspect of a patient’s care or situation with friends, family, or others outside the practice.
  • Not discussing a patient’s medical condition or history with the patient unless instructed to do so by Dr. Paine.




Important Phone Numbers
Client Services:  518-452-9919  413-232-6144
Emergency Number:  518-505-7359

At the time of your visit:

  • Please remember to present your insurance member ID card.
  • Your co-payment is due.


  • Please remember that referrals are issued after consultation with Dr. Paine.
  • The decision to issue a referral is at the discretion of Dr. Paine and your insurance company.
  • Referrals for certain services may require the prior approval of your insurance company in consultation with Dr. Paine.
  • It is your responsibility to be aware of the time period noted on the referral.



Responsibility of the Therapist

  • To provide respectful, positive, sensitive policies and interactions
  • To make clear policies and procedures to assure confidentiality, increase awareness, and decrease confusion

Responsibility of the Client

Payment is made at the time of the visit.  If you need a statement for insurance purposes, we will send it to you weekly

  • so that you can submit it to your insurance carrier for reimbursement.
  • If you are unable to keep an appointment, please notify us immediately.  If an appointment is cancelled without 24-hour notice, you will be billed for the session.  If you fail to show up for your appointment, you will also be billed for the session.   

Responsibility for Records and Rights

Confidentiality is a very critical issue.  Any personal information that you share with us may be entered into your records in written form.  Your records routinely include appointment dates and progress notes.  Every effort is made to avoid any entry of information which may be sensitive or embarrassing.  The only individuals with access to our files are staff members who are directly involved in providing services.  Each staff member is acutely aware of the strict confidential nature of all records.  No outside person is allowed to access our files without your written consent.

All records are kept in locked file cabinets.  All closed cases are stored in inaccessible files.  In our building we have security, passwords to protect databases, and virus/intrusion detection software.  Access to your insurance information, history, and psychotherapy progress notes is limited to Dr. Paine only.  

Billing occurs regularly to health insurance companies.  The bill identifies you, your diagnosis, procedures, and cost.  There is no electronic billing to insurance companies from this office. 

Although your record is the physical property of Parakalein Counseling Services, the information belongs to you.  You have the right to:

  • Obtain a copy of this privacy notice.
  • Inspect your record and obtain copies.
  • Amend your record by attaching a statement.
  • Obtain a written copy of disclosure of your information to others.
  • Request a restriction on disclosures of your information to others.



In New York State and the Commonwealth of Massachusetts, you have the right to a copy of your records, unless seeing them could be emotionally damaging to you. 

If you have any questions, please contact Dr. Donald L. Paine at 518-452-9919 or in writing to one of our office locations.

While any conflict should be resolved with the client and the therapist or agency, if you believe that your privacy rights have been violated, and you are unable to resolve your complaint, you can contact the following organizations: 

NY State Education Department, Office of Professions
Division of Professional Licensing Services
Social Work Unit
89 Washington Avenue
Albany NY 12234-1000
Phone:  518-474-3817 ext 250
Fax: 518-402-5354
Web Address:

Massachusetts Board of Registry of Social Work
239 Causeway St.
Suite 500
Boston MA  02114
Phone:  617-727-3073
Web Address:

National Association of Social Work, Northeastern NY Chapter
188 Washington Avenue
Albany, NY 12210
Phone:  518-463-4741
Web Address:

Release of Information

There may be some reason that you wish to have a third party provided with information in your records (e.g., probation office, courts, physician, another therapist, school personnel, etc.).  We will ask you to sign a release of information form authorizing the transfer of information.  This allows us to discuss your case, or provide written information to the person(s) you request.  You may revoke your permission at any time by providing us with a written notice.  Information is routinely released to obtain payment for services (especially insurance reimbursement), in which case disclosure is limited to the minimum that is necessary to achieve that purpose, namely diagnosis, procedure code, date of appointment, and basic information about you and the insured (address, date of birth, etc.).  Sometimes there are cases in which your insurance company or HMO will ask to review your file as a part of their quality assurance.  In these situations, we will ask your permission before we share your record with them.




There are several important reasons confidential information may be released to others:

  • If you have been mandated by your employee assistance program, you can assume that they wish to receive some type of report of evaluation.  You should discuss with us exactly what information may be included in such a report before you disclose any confidential information.  In such instances, you have a right to tell us what you want us to know. 
  • If you are involved in litigation of any kind and inform the court of the services that you received from Dr. Paine (making your mental health an issue, e.g.), you may be waiving your right to keep your records confidential.  You may wish to consult an attorney regarding such matters prior to disclosing that you have had, or are having treatment. 
  • If you threaten or harm either yourself or someone else, and we believe your threat to be serious, we are mandated under law to take whatever actions deem necessary to protect people from harm and to protect you. 
  • If we have reasonable cause to believe that a child or elderly person is being abused, neglected, or in danger in any way, we are mandated by law to report all forms of child or elder abuse, including neglect, to the New York or Massachusetts Children and Family Services. 
  • We may be required to disclose health information to Worker’s Compensation to comply with their requests for issues related to work and your mental health. 



You can download the HIPPA Release Form in both Adobe Acrobat and Microsoft Word formats.  If you are a PC user, right-click over the document and "save link as..."  If, on the other hand, you are a MAC user, click and hold over the document and "save link as source."


HIPPA Release Form  
HIPPA_Release_Form [3K] HIPPA_Release_Form.doc [20K]

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251 New Karner Road, Albany, NY 12205 518-452-9919
2 Swamp Road, West Stockbridge, MA 01266 413-232-6144

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