Example of a Psychological Therapeutic Contract

THERAPEUTIC CONTRACT

Contract entered into between “CITCA” (Interactive Center for Treatment Against Addictions S.C), the patient's name Carlos Javier López Denis 23 years old, with identification LPT2658SRT, address Av. Flopres in Attic No. 123 Col Cinematographer Delegación Coyoacán. Mexico D.F C.P. 326541

• The family member responsible for him is Mr. Javier López Cerrillo (Father of the patient)
• Telephone and contact 55 - ** - 65-98-93
• Responsible family member:

Medical Record No. 25684 Date 

Contract: September 23, 2014 Code: 0712lunnert.

Responsible physician: Dr. Jesús Ángel Santos Celestino, Ced Prof: 8125658

Institution data

It is located in Rancho La Esperanza, on the Mexico Querétaro Highway 18000 Quilometer, its Operation record is SSA 235687412, issued by the Secretary of Public Health of the State of Queretaro.

Introduction:

This therapeutic contract will establish the rules and procedures that must be followed by the responsible parties.

• Institution
• Responsible family member
• Patient

1.- The “CITCA S.C” institution will apply to the patient a rehabilitation program called Capasi-vida, in which they will get used to living without addictive and enervating substances, as well as controlling their impulses and behaviors, both social and particular, as well as a coexistence with their family and friends that has been undermined by disorderly attitudes and conflicting.

Your attention will be prepared with a team of professionals including:

• Doctors (of all specialties)
• Nurses specialized in treating violent people
• Nurses specialized in treating people with weak emotions
• And a team of professionals who will advise and keep a record of all the processes to which the patient is linked.

The doctors will be supervised by a human rights protector who permanently resides in this institution and who will have authorization to fully tax the sessions, of which they will have a copy for the record and a copy for the family members of the patient.

The treatment is focused on chemicals such as:

• Alcohol
• Heroin
• Cocaine
• Amphetamines
• THC
• Crack
• LSD

Addictive behaviors such as:

• Cut
• Anorexy
• Bulimia
• Neurosis etc.

A harmonious recovery will be sought, which allows personal improvement, non-dependence on substances, an acceptable social and family coexistence and a future in life.

Clauses

1.- The rehabilitation program has been chosen voluntarily by the patient and their family member responsible, after a full and comprehensive explanation of the problem and the solution plan feasible.

2.- This program may be changed or altered for the benefit of the patient, with the prior consent and authorization of the patient and the family member responsible for him.

3.- The patient may be in one of these two regimens:

• Ambulatory
• Internship

Which will depend on the degree of intoxication and violence that he may present, as well as the control that he himself has.

4.- The patient and his family member will be well informed of the type of treatment and the way in which it will be carried out, so that the benefit is as optimal as possible and in the shortest possible time.

5.- The family member will be committed not to abandon the patient, and if he does, he will be under the I safeguard the state and the government, who will take the corresponding precautionary measures in accordance with the law.

6.- In the previous case, the institution will not stop providing medical and detoxification services to the patient.

7.- When their intoxication is low or nonexistent, the patient must enter the assignments and circles.

Payments:

Being a civil institution, constant payments will be made which will have an amount of 5000 (five thousand pesos) in the initial transfer, which involves food, clothing, general support and treatment doctor.

The following payments will be 2,500, which are based on the needs of the patient.

When the patient passes to the outpatient degree, his payments will be reduced to 1500 per month, but for the corresponding reduction The patient will have to carry out insertion work and help with patients with greater damage or in rehabilitation (they must to collaborate).

To be discharged and complete their rehabilitation, the patient must make a final payment of 5000 (five thousand pesos), as recovery payment for the improvements and salaries of the employees of the institution.

Proceedings:

The patient will have the right to a full copy of his file, but for reasons of secrecy professional, it will be delivered only in the event that there is a controversy or it is indispensable on the part of of the patient.

Those who compose it who will give their signatures and consent are in accordance with this contract and its all parts.

Doctor
representative of the institution
Firm

Family Patient
Signature Signature