LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychotherapist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The other professionals are also legally bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together. I will note all consultations in your Clinical Record (which is called “PHI” in my Notice of Psychotherapist’s Policies and Practices to Protect the Privacy of Your Health Information). • You should be aware that I practice with other mental health professionals and that I employ administrative staff. In most cases, I need to share protected information with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff members have been given training about protecting your privacy and have agreed not to release any information outside of the practice without my permission. • I also have a contract with a billing service. As required by HIPAA, I have a formal business associate contract with this business, in which it promises to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law. If you wish, I can provide you the name of this organization and/or a blank copy of this contract. I also will ask for your permission before having the billing service contact you. • Disclosures required by health insurers or to collect overdue fees are discussed elsewhere in this Agreement. • If a patient threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection. There are some situations where I am permitted or required to disclose information without either your consent or Authorization: • If you are involved in a court proceed...
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a psychotherapist. In most situations, I can only release information about your treatment to others if you sign a written authorization form. There are some situations where I am permitted or required to disclose information without either your consent or authorization. Please see the attached “Notice of Policies and Practices to Protect the Privacy of Your Health Information” for more information. A summary is provided below: ▪ If a client threatens to harm himself/herself or others, I may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection. ▪ If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychotherapist-client privilege law. I cannot provide any information without your (or your legal representative’s) written authorization, or a court order signed by the judge requiring it. If you are involved or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information. ▪ I am required to comply if a government agency requests information for health oversight activities. ▪ If a client files a complaint or lawsuit against me, I may disclose all relevant information in order to defend myself. I am legally obligated to take action, such as making a report to a protective agency or warning a potential victim, which I believe is necessary to protect others from harm, and thereby revealing information about a client’s treatment. These situations are unusual in my practice. I have outlined situations that would legally obligate me to take action: ▪ If I have reasonable cause to suspect a child has suffered harm as a result of child abuse or neglect and it has not already been reported. ▪ If I have reasonable cause to believe a vulnerable adult suffers from abandonment, exploitation, abuse, neglect, or self-neglect; or a disabled person has been abused. ▪ If a client communicates an immediate threat of serious harm to an identifiable victim, I may be required to notify the potential victim, contact the police, and/or seek hospitalization for the client. If any such situation arises, I will make every effort to discuss it with you before taking any action, and I will try to limit my disclosure to what is necessary. While this written summary o...
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. With your signature on a proper Authorization form, I may disclose information in the following situations:
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between you and your provider. In most situations, RCC will only release information about your treatment to others if you sign a written Authorization Form for each release. Our release forms meet certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advanced consent. Your signature on this Agreement provides consent for those activities, as follows:
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The other professionals are also legally bound to keep the information
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a licensed therapist. In most situations, your therapist can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA and/or Illinois law. However, in the following situations, no authorization is required (see Appendix B for details):
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a therapist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. There are some situations, which are listed below, in which I am legally obligated to break confidentiality. If any of the following situations arise, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary. • If I have reasonable cause to believe that a person under age 18 has suffered abuse or neglect, the law requires that I file a report with the appropriate government agency, usually the Department of Social and Health Services. Once such a report is filed, I may be required to provide additional information. • If I have reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, the law requires that I file a report with the appropriate government agency, usually the Department of Social and Health Services. Once such a report is filed, I may be required to provide additional information. • If I reasonably believe that there is an imminent danger to the health or safety of the client or any other individual, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, seeking hospitalization for the client, or contacting family members or others who can help provide protection. • If you tell me that you are suffering from HIV-related illness and do not have a physician providing for your care, I may be required to report the identities of your IV drug using or sexual partner(s) to the local health care officer. • Under court order, I can be required to disclose my records and information that I have about you. • If a government agency is requesting the information for health oversight activities, I may be required to provide it for them. • If a client files a complaint or lawsuit against me, I may disclose relevant information regarding that client in order to defend myself. • If a client files a worker’s compensation claim, and the services I am providing are relevant to the injury for which the claim was made, I must, upon appropriate request, provide a copy of the client’s record to the client’s employer and the Department of Labor and Industries.
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a mental health professional. In most situations, mental health professionals can only release information about your evaluation and/or treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities as follows: o I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, every effort is made to avoid revealing the identity of the client. The consulted professionals also are legally bound to keep the information confidential. If you do not object, you will not be informed about these consultations unless your therapist determines that it is important to do so. All such consultations will be noted in your Clinical Record (which is called “PHI” in the Notice of Policies and Practices to Protect the Privacy of Your Health Information). o You should be aware that this practice has administrative staff. In most cases, I will need to share protected information with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All mental health professionals are bound by the same rules of confidentiality. All staff members have received training about protecting your privacy and have agreed not to release any information outside of the practice without the permission of a mental health professional. o Disclosures required by health insurers or any other disclosure necessary to obtain reimbursement for services. This matter is discussed in more detail elsewhere in this Agreement. o If a client seriously threatens to harm himself/herself, mental health professionals may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection. Texas law provides that a mental health professional may disclose confidential information only to medical or law enforcement personnel if the mental health professional determines that there is a probability of imminent physical injury by the client to the client or others, or there is a probability of immediate mental or emotional injury to the client. There are some situations where mental health professionals are permitted or required to disclose client information without t...
