Online Store   |   Advertising   |   Print Page   |   Contact Us   |   Report Abuse   |   Sign In   |   Join
A Sample of a Professional Will
Share |

10/31/12

As part of its efforts to guard the quality and care of client treatment, Resource Management Services, Inc., in Peoria, Ill., requires that all clinical staff “complete a professional will that outlines the actions to be taken for the care of their clients, their records, and compensation due to you, should you become functionally incapacitated or deceased.”

    Below is the sample of a professional will for clinical mental health counselors that Resource Management Services provides its clinical employees. See the related 
Advocate article on professional wills.


Professional Will or Executor Instructions for the Disposition of 
Clients of __________________________________, 
in the Event of Death, Disappearance, or Disability


A.    The Professional Executor:

    ______________________________________________________________________ 
    and/or 
    The Staff of [list name and address of your practice here]
    ______________________________________________________________________

    ______________________________________________________________________
    

    ______________________________________________________________________

B.    My Attorney:

    ______________________________________________________________________    
    

    ______________________________________________________________________ 
   

    ______________________________________________________________________

C.    My Accountant:

    ______________________________________________________________________    
    
    ______________________________________________________________________    

    
    ______________________________________________________________________    
     
    ______________________________________________________________________

D.    General Information:

  • Office Location: ___________________________________________________
  • Keys to my office and file cabinets are located: _______________________
  • Closed client files are located: ______________________________________
  • Open client files are kept: __________________________________________
  • My personal appointment book is kept: _______________________________ __________________________________________________________________
  • Billing records are kept by the professional executor.
  • License, malpractice policy, and managed- care contracts are kept by the professional executor.
  • All client records must be handled only by the professional executor.
  • The professional executor will assist in notification and/or therapeutic issues to be addressed with my clients.
  • Billing issues, insurance, and other administrative details already handled by the professional executor will continue to be handled by that person.

E.    Specific Instructions to the Professional Executor

  1. In the event I am unable to work for more than two weeks but can communicate effectively, please contact me about how to proceed. Whatever we discuss at that time will take precedence over this document.
  2. In the event of my death, disappearance, or in the event of temporary or permanent decisional incapacitation, the professional executor should take the following steps:
    a. Telephone all scheduled clients and notify them of my current circumstances. Assess clients’ need for ongoing therapy. After review of my treatment notes and your telephone assessment, make professional referrals as appropriate. If the client accepts the referral, please obtain the client’s consent to release the records to the designated therapist. Please attend to insurance or managed-care needs and requirements.
    b. When clinically appropriate, please offer my clients one face-to-face contact to process my death or incapacitation with them. If they can not afford it or the insurance company denies such a session, cover the costs from my outstanding earned salary, or bill my estate.
  3. Copies of referred clients’ records should be forwarded to their new therapists. All remaining records should be maintained and/or destroyed as is customary by the professional executor and as advised by the guidelines of the American Psychological Association.
  4. Please defer to my designee _______________________________ or executor of my estate ______________)))______________________, any financial decisions to be made regarding outstanding bills or compensation that is due. If a review of the clinical file is needed to ascertain the outstanding earnings due, please conduct such a review and inform my estate executor of the resulting amounts.
  5. Please notify in writing all managed-care or insurance companies of my circumstances.
  6. There are three copies of this Professional Executor Instructions document. The first is located with my other personal papers __________________________________________. The second is held by the professional executor. The third is on file with my attorney.
  7. Charge my estate for the cost of professional time and other reasonable expenses incurred as the result of these instructions.
  8. This professional living will is established and shall be governed by the laws of the state of _____________________. I intend that this power of attorney be universally recognized and admissible in any jurisdiction.



_________________________________________________   ____________________
Therapist                                                                                Date


_________________________________________________   ____________________
Professional Executor                                                               Date


_________________________________________________   ____________________
Witness                                                                                  Date 


From RUSSELL–CHAPIN. Clinical Supervision, 1E. © 2012 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission. <www.cengage.com/permissions>.

About
    Membership     Careers & Education     News & Publications
Mission and Vision     Join AMHCA     Career Center     News
About Mental Health Counselors     Membership Benefits     Continuing Education     The Advocate Magazine
Contact Us
    Student Member Benefits           AMHCA Blogs
AMHCA Marketing     Scholarships and Awards           Journal of Mental Health Counseling
Governance               White Papers
States and Chapters                 Clinical Practice Briefs
AMHCA Diplomate Credential                 AMHCA Standards for Practice
Find a Counselor      Conference     Advocacy     AMHCA Code of Ethics
FAQ           Take Action     AMHCA Research
Donate                  

©2016 American Mental Health Counselors Association

The AMHCA is a 501(c)(3) not-for-profit organization. Privacy Policy Terms of Use
Phone: 800-326-2642 or 703-548-6002