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Professional Will Template

This document provides a template for psychoanalysts and psychotherapists to organize information about winding down their practice in the event of incapacity or death. The template addresses appointing an executor, physical office details, scheduling and records, notifying patients, billing, legal matters, digital assets, and annual reviews. The goal is to thoughtfully plan how to handle practical and ethical obligations to help ensure smooth transitions for patients and protect confidentiality.

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HPS_org
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
292 views9 pages

Professional Will Template

This document provides a template for psychoanalysts and psychotherapists to organize information about winding down their practice in the event of incapacity or death. The template addresses appointing an executor, physical office details, scheduling and records, notifying patients, billing, legal matters, digital assets, and annual reviews. The goal is to thoughtfully plan how to handle practical and ethical obligations to help ensure smooth transitions for patients and protect confidentiality.

Uploaded by

HPS_org
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

CATHERINE STEVENSON, MD

DISCLAIMER: This presentation and worksheet template are looking at the ethical implications of end of life planning in the context of the practice of psychoanalytic and psychodynamic therapy. Ne legal advise is being given.

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

EXECUTOR
Who is in charge of executing this plan?
Name

How can he/she be contacted?


Phone Email Cell Phone

Address

If he/she is not available who are 2 other people who would be willing to take charge?
Name Phone Email Cell Phone

Address Name Phone Email Cell Phone

Address

Will the executor be paid?

If so, how much?

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

PHYSICAL ADDRESS
Location of my office:
Street Address City State Zip

Are there other satellite offices?

Where would one find the keys to:


The Building The Office The Files The Mail Box

Are there other important keys?

If the office is rented who is the landlord or management company, and how would they be contacted?

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

SCHEDULE
Please explain in detail where your schedule is kept, how it is accessed, and is there any back up copy. In the event of an emergency this will be the first critical priority.

CONTACTS
Where do you keep your patient/client information, and how is it accessed?

RECORDS
What should happen to your charts?

If they are not destroyed who will keep them, and how would patients, clients or other practitioners know how to get them?

Are there any electronic medical records?

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

NOTIFICATION
Who should notify your clients/patients of your demise or incapacitation?
Name

How can he/she be contacted?


Phone Email Cell Phone

Address

How would you think this might best be handled?

Are there colleagues who should be notified?

Are there professional organizations who should be notified?

INFORMED CONSENT
Do you have any concerns around the issue of informed consent regarding the release of patient/client contact information and records to the executor and others helping with this process?

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

BILLING
How is your billing handled?

If you use a billing service or acountant how can they be contacted?


Name Phone Company Email

LEGAL
Do you have a personal attorney?
Name Phone Company Email

Are there any conflicts between your personal will and professional will?

Do you need to make provision for paying salaries of any support staff?

Where will you keep copies of your professional will and who will have access to it?

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

DIGITAL
Are there any passwords the executor will need to your voice mail, email, desk top computer, laptop, smart phone, iPad, EMR, billing software or other elements of your practice?

Do you use a password safe like eWallet?

What will happen to your website?

Do you use any social networking in a professional context like Linked In or Facebook?

Perphaps a good date to consider an annual review of these issues would be May 15, the Feast of Saint Dymphna, patron saint of mental and nervous disorders. We will add a reminder note to the Society calendar.

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

NOTES

Houston Psychoanalytic Society

ethics workshop

PUTTING TOGETHER A PRFESSIONAL WILL A Template to Reflect on the Issues and Organize Ideas

NOTES

Houston Psychoanalytic Society

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