At Rula, care is structured around one Primary Identified Client (primary patient). Secondary partners and collateral family members do not have individual Rula medical records or account profiles, nor do they complete a standard Release of Information (ROI). Instead, their participation is documented by the Secondary Partner Intake Demographic Form and the Couples Therapy: Agreement & Informed Consent, both of which should be uploaded by you as their provider, directly into the primary client’s chart.
Secondary partners or collateral contacts may sometimes need external resources, individual therapy, or a Higher Level of Care (HLOC). When sharing these resources, provide external options directly while keeping all documentation to the primary client's record. While the majority of your clinical documentation will be tied to the primary patient's treatment, you can and should clearly document that you provided resources to the secondary partner. You can do this by completing a blank note in the chart, even if you are not documenting how that specific need impacts the primary patient.
Considerations for referral appropriateness
Navigating Higher Level of Care (HLOC) needs or specialized referrals for a secondary partner or family contact can feel tricky, especially when you want to make sure they get connected to the right support. Evaluating whether to make a referral or provide resources for a secondary partner, family member, or collateral contact requires balancing relational neutrality with clinical safety and scope of practice. Keep in mind, however, that Rula’s internal Care Coordination team can only process care transitions for primary identified clients who have active individual Rula charts.
As such, submitting an internal Care Coordination ticket for a secondary partner or collateral family member will be ineffective and can inadvertently delay access to care.
What to do instead: When a secondary partner or family member needs individual therapy or a higher level of care, the most effective approach is to provide them directly with local facility intake numbers, share public directory links, or guide them on how to register as a new primary client with a different Rula provider.
Decision matrix: Referral and resource pathways
Clinical scenario |
Participant status |
Recommended provider action |
Rula workflow and documentation |
|---|---|---|---|
| Secondary partner needs independent individual therapy | Secondary partner (no Rula chart) | Guide them to sign up independently as a primary client with a different Rula provider or provide general external provider directory links (e.g., Psychology Today, SAMHSA). | Document resource sharing in the primary client’s chart via blank note. Do not open an individual chart under your own practice. |
| Secondary partner requires Higher Level of Care (HLOC: IOP/PHP/Residential) | Secondary partner (no Rula chart) |
Refer the individual back to their health plan for resources and in-network treatment options. Provide direct intake phone numbers for local accredited HLOC facilities. If pausing couples care, outline clinical rationale to the couple and in the chart. |
Document HLOC recommendation in the primary client’s chart. Attach any completed consents to the chart. |
| Collateral member (e.g., parent/relative) needs mental health resources | Collateral participant |
Refer the individual back to their health plan for resources and in-network treatment options. Guide them to sign up independently as a primary client with a different Rula provider. Share general community directory links (211, support group links, findhelp.com) during session or via email. |
Log general resource delivery as a blank note in the primary patient’s chart. Do not record collateral PHI as primary client data. |
| Secondary partner requests copy of joint resources or session notes | Secondary partner (signed consent) | Refer to the signed Couples Therapy: Agreement & Informed Consent regarding record access and legal patient definitions. Having a ROI on file is also best practice for sharing session notes. | Upload signed agreement to primary client's chart. Share general, non-PHI educational resources directly. |
Navigating higher level of care (HLOC) referrals for secondary partners
When a secondary partner shows signs of acute decompensation (e.g., severe active addiction, severe eating disorder symptoms, or acute suicidality) requiring Intensive Outpatient (IOP), Partial Hospitalization (PHP), or Residential treatment:
- Facilitate external intake, but don't diagnostically assess: Because the secondary partner does not have an individual Rula chart under your care, you cannot perform a formal diagnostic assessment or Level of Care assessment for them.
- Adapting couples care: If the secondary partner enters an intensive HLOC program (e.g., residential detox), pause conjoint couples therapy until the secondary partner is clinically stabilized and cleared for relational work by their HLOC treatment team.
Obtaining direct contact information for secondary partners
Because secondary partners do not hold a Rula account profile, providers will need to capture accurate demographic and contact information during onboarding to support safety and resource delivery.
Workflow for collecting secondary partner details
-
Administer the Secondary Partner Intake Demographic Form: Do this during intake or early sessions. This form captures:
- Full legal name and preferred name
- Date of birth
- Direct phone number and direct email address
- Physical address
- Previous therapy experience and health/medication details
- Emergency contact information
- Chart storage protocol: Once completed, upload the form directly into the primary client's Rula chart and document a blank note referencing the upload.
- Prevent profile overwrites: Never replace the primary client’s phone number or email in Rula’s Provider Portal with the secondary partner’s contact details. Doing so may cause automated appointment reminders, billing notifications, and portal links to be sent to the wrong person, resulting in a potential privacy breach.
Sending resources to secondary partners
Because secondary partners do not complete a standard ROI or possess a Rula portal login, use the following approved methods to transmit care resources:
- In-session sharing (recommended): Share resource links, directory sheets, or HLOC contact guides during joint sessions using the Zoom document share feature or chat.
- HIPAA-compliant direct email: Transmit general, non-personalized community directories, support group flyers (e.g., NAMI, Al-Anon), or HLOC intake numbers to the secondary partner’s direct email address as recorded on their demographic form.
Related articles and resources
- Step-by-Step Workflow for Seeing Couples at Rula
- Documenting Couples/Family Therapy Sessions in an Insurance Environment
- Identifying Levels of Care
- Introduction to Care Coordination Services Available at Rula
- Conducting a Level of Care Assessment
Updated