Consent for Treatment/HIPPA Confidentiality
As a rule, your counselor will disclose no information about you, or the fact that you are our patient, without your written consent. Your formal mental health record describes the services provided to you and contains the dates of our sessions, your diagnosis, functional status, symptoms, prognosis and progress, and any psychological testing reports. Health care providers are legally allowed to use or disclose records or information for treatment, payment, and health care operations purposes. However, your counselor does not routinely disclose information in such circumstances, so your counselor will require your permission in advance, either through your consent at the onset of our relationship (by signing a general consent form), or through your written authorization at the time the need for disclosure arises. You may revoke your permission, in writing, at any time, by contacting your counselor.
Your counselor will make every effort to keep your personal information private. There are some limitations to confidentiality to which you need to be aware. Your counselor may consult with a supervisor or other professional counselor in order to give you the best service. In the event that your counselor consults with another counselor, no identifying information such as your name would be released. Counselors are required by law to release information when the client poses a risk to themselves or others and in cases of abuse to children or the elderly. If your counselor receives a court order or subpoena, the counselor may be required to release some information. In such a case, your counselor will consult with other professionals and limit the release to only what is necessary by law.
Confidentiality and Group Therapy
The nature of group counseling makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that your counselor cannot guarantee that other group members will maintain your confidentiality. However, your counselor will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. Your counselor also has the right to remove any group member from the group should she discover that a group member has violated the confidentiality rule.
Technology
Some clients may choose to use technology for correspondence with their counselor. This includes but is not limited to telephone, email, text, or chat/video counseling. Due to the nature of technology communication, there is always the possibility that unauthorized persons may attempt to discover your personal information. Your counselor will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used for communication. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used to communicate with your counselor.
CONSENT TO WIRELESS TELEPHONE CALLS:
If, at any time, you provide wireless telephone numbers to Mindful Healing at which you may be contacted, you consent to receive calls (including autodialed calls and prerecorded messages, automated appointment reminders) at that wireless number from Mindful Healing, its successors and assigns, and its affiliates, regarding the services rendered, hospitalization, and/or my related financial obligations.