Partners in Caring Counseling Guidelines
CURE Childhood Cancer, Inc. (“CURE”) recognizes the impact that a childhood cancer diagnosis can have on the whole family. CURE’s family-centered approach to addressing these unique experiences includes partnering with a network of licensed community-based therapists to offer counseling sessions to CURE families.
A family’s circumstances must include one of the following to be considered eligible to receive support through CURE’s Partners in Caring Counseling Program (the “Program”):
- A child diagnosed with cancer, LCH, HLH, or aplastic anemia
- A child who relapsed with cancer, LCH, HLH, or aplastic anemia
- A child who passed away from cancer, a cancer- related circumstance, LCH, HLH, or aplastic anemia
CURE provides up to 10 counseling sessions for each eligible family. The first session is free; for each session thereafter, (sessions 2-10), the family will pay the therapist directly a $25.00 co-pay per session. The 10 sessions may be used in any combination to best support the family’s needs: individual counseling, couples counseling, family counseling, etc. However, CURE is only able to cover a maximum of 10 sessions per family. The 10 sessions are considered a once-per-lifetime benefit and do not renew.
Once you have signed and returned this form to CURE, we will issue you an authorization code (CUREXXXXXX). Once you have received your authorization code you are responsible for contacting the therapist directly to schedule an appointment.
We understand that sometimes appointments have to be canceled. You are responsible for canceling a scheduled session at least 24 hours in advance to avoid being charged a cancellation fee equal to the co-pay. The cancellation fee will be waived if the missed appointment is the direct result of a medical issue related to your child’s illness.
The Summit Counseling Center and the center and/or therapist providing counseling services (the “Provider”) are committed to patient and family confidentiality, and they comply with applicable law (e.g., HIPAA) and guidelines to protect the privacy of healthcare information. CURE authorizes sessions for participants utilizing a limited release of protected health information This does not authorize the Providers to disclose clinical information to CURE regarding patients or their families.
CURE Childhood Cancer offers the Program solely to support patients with childhood cancer, LCH, HLH, or aplastic anemia, as well as the families of such patients. While CURE has chosen to partner with an accredited center with state-licensed Providers, CURE has no responsibility for, and makes no representations or warranties with respect to, a) the actions or inaction of Providers who render counseling and other services through this Program, including, but not limited to, any action taken by such Providers based on their perceived or actual legal or ethical obligations to report to legal authorities or other third-parties information obtained during the course of providing services as a part of the Program; b) the information provided by the Providers in any form, whether printed or electronic; c) the quality or outcome of services provided through this Program; or d) the ability of Providers to provide the contracted services, including any express, statutory, and implied warranties of treatment outcome. CURE reserves completely the right to alter the type and nature of the programs or services offered. By participating in the Program, patients and their families agree to hold CURE harmless for any breach of professional liability while receiving services from Providers.
By signing below, I give CURE Childhood Cancer permission to provide my name, contact information, and limited health information regarding the child with cancer to the Providers providing counseling services. By signing I am also stating that I have read and understand these Guidelines and the Disclaimer provided above.