Confidentiality
Any information you share with a staff member is considered
confidential, even the fact that you are a client at Chilton-Shelby
Mental Health Center. When there is a need to release information about
you, you will be asked to sign a "Release of Information"
form. A staff member will tell you what information will be requested or
released. Clinical information, either written or verbal, will not be
released by this center without your written permission except in the
following instances:
- If there is evidence of abuse or neglect or suspected child abuse
or neglect.
- If the center is ordered by a judge.
- If you express intent to harm yourself or others.
- If you have a medical emergency.
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Fees
Payment for services is expected at the time of the service. The
center will file your insurance (Blue Cross/Blue Shield, United
Behavioral Health, Medicare, Medicaid, etc.) for you if you provide us
with all the necessary information to do so. If you have insurance that
would cover our service but choose not to file, you will be responsible
for the full fee. Some healthcare plans may require a call from you
before sessions are approved. If you fail to do this prior to your
scheduled appointment, you will be expected to pay full fee for the
service you receive.
Application for Discounted Fee
If you are not covered by an insurance plan or have limited benefits
under your plan, you may wish to apply for discounted fees based on your
total income and size of your family. To qualify for discounted fees, it
is necessary for you to provide the following information for
verification of income:
 | Most recent year's tax return, or |
| Paycheck stubs for one month, or |
| Statement from the Foods Stamp Office |
You are requested to notify the Center if there is a change in the
income or size of your family since this may affect your fee.
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Appointments
It is important you keep every appointment to ensure the best
progress toward your treatment goals. If you are unable to keep an
appointment, please notify the Center as soon as possible. Check our Directory for the phone number of the office you need to reach.
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In Case of an Emergency
In case you have a mental health related emergencies in the evenings,
on weekends, or on holidays, call the 24 hour emergency number:
| Shelby County 205-663-1252 |
| Chilton County 205-755-5933 or 205-755-8803 |
Your call will be directed to our Answering Service and a
professional counselor will be contacted to help you deal with your
emergency. Since the counselors are "on-call" on a rotating
basis, the counselor that you reach may not be your regular counselor.
Therefore, problems which are not emergencies should be discussed with
your regular counselor during your scheduled appointment time.
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Consumer Rights
Consumer Rights for Persons Enrolled in Chilton-Shelby Mental
Health Center Services
- Right to Privacy
- Right to Confidentiality
- Right to Access Information
- Right to Access Compliance/Grievance Procedures
- Right to be informed of financial aspects of treatment
- Right to be fully informed of need for parental or guardian
consent
- Right to be fully informed of services provided
- Right ti give informed consent prior to being involved in
research projects
- Right to be protected from harm including any forms of abuse,
neglect, exploitation and mistreatment
- Right to access courts and attorneys
- Right to be informed of commitment status if legally committed
- Right to be accorded adequate services, humane respect and
dignity, regardless of the source of financial support
- Right to refuse mental health services, except when refusals are
not permitted under applicable law
- Right to be informed of means of accessing advocates or rights
protection services
- Right to be free from seclusion, restraint, drugs or other
interventions administered for punishment, discipline or staff
convenience
- Right to be included in the community with appropriate and
adequate supports on completion of, or in conjunction with, the
terms of commitment
- Right to be advised when special equipment, such as two-way
mirrors, cameras, and tape recordings are used
- Right to enforce rights through courts or appropriate
administrative procedures
- Right to receive quality treatment and care from trained
professionals regardless of your race, religion, gender, sexual
orientation, ethnicity, age or disability
- Your plan of treatment of habilitation should be designed just
for your individual needs and abilities.
- You should be allowed to actively participate in your treatment
plan. There will be a periodic review of the treatment or program
plan.
- The right to individualized treatment providing services within
the least restrictive environment possible
- Right to care that is considerate and respects the consumer's
personal values and belief systems
- Right of the individual served and the individual's family to be
informed of their rights in a language they understand
- Right to be informed of the organization's rules and regulations
concerning the conduct of the individuals served
- Right to adequate number of competent, qualified, and
experienced professional clinical staff to supervise and carry out
the treatment or program plan
These rights are available to you as a consumer of mental health
services, although there may be some limitations based upon your
circumstances.
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Residential Services Consumer Rights
- Right to adequate food and shelter in residential programs
- Right to access medical services in residential programs
- Right to wear your own clothing and keep your own personal
possessions
- Right to privacy of mail, telephone communications and visitors,
unless legally restricted
- Right to management of personal funds to the maximum level of
each consumers ability
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Other Consumer Rights
Consumers have the same rights afforded to all citizens.
- Right to receive a free and appropriate education if you are of
school age
- Right to exercise freedom of religion
- Right to be paid the value of work performed
- Right to exercise rights as a citizen of the United States and
the state of Alabama
- Right to be served through general services available to all
other citizens
- Right to choose to live, work, be educated and recreate with
persons who do not have disabilities
- Right to be presumed competent until a court of competent
jurisdiction, abiding by statutory and constitution provision,
determines otherwise
- Right to vote and otherwise participate in the political process
- Right to own and possess real and personal property (Nothing in
this section shall affect existing laws pertaining to conveyance
of personal property.)
- Right to make contracts
- Right to exercise rights without reprisal
- Right to obtain a driver's license on the same basis as other
citizens unless excluded due to violation of the law
- Right to marry and divorce
- Right to sexual interaction with members of either sex (Romantic
relationships between active group therapy members are discouraged
for therapeutic reasons.)
These rights may be limited based upon an individual's specific
circumstances
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Consumer Responsibilities
Realizing the freedom to exercise rights carries the need to accept
some responsibilities. The following list of responsibilities is
expected of each person who receives services from the Chilton-Shelby
Mental Health Center.
- To provide, to the best of your knowledge, accurate information
regarding your mental health and medical history including: present
and past illnesses, medications, hospitalizations, etc.
- To be responsible for your actions should you refuse treatment or
do not follow instructions
- To be familiar with and follow rules and regulations governing
your care and conduct
- To attend scheduled activities and keep appointments
- To be considerate of the rights of others
- To be respectful of the property of others and of the facility
- To take an active part in planning for your treatment/habilitation
program
- To ask questions when you do not understand instruction,
treatment, etc.
- To help take care of and clean up your service area as appropriate
- To obey the laws which apply to all citizens
- To pay for services as per agreement
There may be other specific rules and responsibilities as outlined
within services.
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Complaint/Grievance Procedures
Any person or agency who applies for or receives any service from
Chilton-Shelby Mental Health Center may file a complaint/grievance.
Informal complaints may be given to any staff member or supervisory
personnel. Those staff members may resolve the complaint quickly, in an
informal manner. In the event the person with a complaint is not
satisfied with the resolution of the complaint, the person may file a
formal complaint/grievance.
The informal complaint process will not apply in cases where there is
alleged abuse or neglect of a client. Such complaints will be handled as
formal complaints and should be reported to the Executive Director
immediately.
A formal complaint/grievance may be filed in the event the informal
methods do not satisfy the person with a complaint. This complaint
should be directed to the Executive Director's Office. Such companies
should identify the problem and state the relief desired, if any.
The Executive Director may assign supervisory personnel to
investigate and resolve the formal complaint/grievance, if possible. The
Executive Director will be informed of the resolution of the formal
complaint/grievance.
In the event that the person with a complaint is not satisfied with
the resolution, the person may request that the Executive Director
review the complaint and reconsider the relief desired. If the decision
is that the relief desired will not be granted, the person with a
complaint will be notified of the decision.
This procedure may be carried out in accordance with the Community
Advocacy Program of the Alabama Department of Mental Health and Mental
Retardation.
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Rights and Protection Services
If you want to find out more about your rights or how
to file
a complaint when you feel your rights have been violated...
Contact
Chief Executive Officer’s Office
Chilton-Shelby Mental Health Center
P.O. Drawer 689
Calera, Alabama 35040
Phone: 205-663-1252
or
Contact the Alabama Department of Mental Health
and Mental Retardation Advocacy Office
at 1-800-367-0955
Other Advocacy/Protection Services
Alabama Disabilities Advocacy Program
|
|
1-800-826-1675 |
Alliance for the Mentally Ill of Alabama
|
|
1-800-626-4199 |
| Department of Human Resources |
|
|
| Chilton County |
|
1-205-280-2000 |
Shelby County
|
|
1-205-669-3000 |
Mental Health Consumers of Alabama
|
|
1-900-264-6422 |
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