(1) The following information must be printed on all disclosure statements provided to counseling clients in language that can be easily understood by the client:
(a) Name of firm, agency, business, or chemical dependency professional's practice.
(b) Employment address and telephone number.
(c) Name, credential, and credential number.
(d) Billing information, including:
(i) Client's cost per each counseling session;
(ii) Billing practices, including any advance payments and refunds.
(e) A list of the acts of unprofessional conduct in RCW 18.130.180
including the name, address, and contact telephone number within the department of health.
(2) The CDP or CDPT and the client must sign and date a statement indicating that the client has been given a copy of the required disclosure information, and the client has read and understands the information provided.
[Statutory Authority: Chapter 18.205 RCW. 09-14-111, § 246-811-100, filed 6/30/09, effective 7/1/09. Statutory Authority: RCW 18.205.060(15). 00-12-102, § 246-811-100, filed 6/7/00, effective 7/8/00.]