Notice of Privacy Practices
The purpose of this Notice of Privacy Practices is to inform you of how your personal information may be used within our facility, as well as reasons why your personal information could be sent to others outside this facility.
We are pleased that you have decided to use our counseling and/or assessment services. There are several things we want you to know about our confidentiality policy.
Personal problems are sometimes very difficult to talk about. That is why confidentiality is extremely important to us. We take every precaution in protecting the confidentiality of your visit with us and we hope that you will do the same.
WE DO NOT DISCUSS YOUR SITUATION WITH ANYONE EXCEPT FOR THE REASONS CITED BELOW, UNLESS YOU GIVE US WRITTEN PERMISSION TO DO SO. There are three limitations to confidentiality that are beyond your and our control.
1. If we learn about child abuse or abuse of elder or disabled persons, we are required by law to report it to the proper authorities.
2. If, in our judgment, you are dangerous to yourself or others (suicidal or homicidal), we will disclose information in order to help protect you and/or others from harm.
3. If we are required to present records to comply with a court order, it is our legal responsibility to comply.
It is our goal to provide a safe and secure opportunity for you to discuss personal problems with us. We will help you with an assessment of your personal problems and then develop a personal treatment plan with you. This plan may include a referral to another source or agency to help you resolve your problems. We will not make such a referral without your consent to do so.
Your counselor may, on occasion, share information about you with his supervisor, and/or other clinicians within this agency to provide you with the best quality of care possible.
We may, in some cases, need to share information with an individual, other service provider, agency, court, insurance company, other payer, government entity, or referring agency. We will only do so with your written permission via a signed Consent-to-Release from you allowing us to do so.