CONFIDENTIALITY
​As a rule, I will disclose no information about you, or the fact that you are my client, without your written consent. Your record will consist of your attendance and payment for services. As required by law, I will maintain your privacy within the bounds of HIPAA. I do not routinely disclose information regarding our relationship, so I 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 me.
Please remember that you may reopen the conversation at any time during our work together.
LIMITS TO CONFIDENTIALITY
Possible Uses and Disclosures of Mental Health Records without Consent or Authorization.
There are some important exceptions to this rule of confidentiality – some exceptions created voluntarily by my own choice, some because of policies in this office/agency, and some required by law. If you wish to receive therapeutic services from me, you must sign the attached form indicating that you understand and accept my policies about confidentiality and its limits. We will discuss these issues now, but you may reopen the conversation at any time during our work together.
Duty to Warn and Protect: If you communicate to me a specific and immediate threat to cause serious bodily injury or death, to an identified or to an identifiable person, and I believe you have the intent and ability to carry out that threat immediately or imminently, I will take steps to protect third parties. These precautions may include 1) warning the potential victim(s), or the parent or guardian of the potential victim(s), if under 18, 2) notifying a law enforcement officer, or 3) seeking your hospitalization. By my own policy, I may also use and disclose medical information about you when necessary to prevent an immediate, serious threat to your own health and safety. If you become a party in a civil commitment hearing, I can be required to provide your records to the magistrate, you'r attorney or guardian ad litem, or law enforcement officer, whether you are a minor or an adult.
Abuse of a Child: If I have reasonable cause to believe that a child has suffered abuse or neglect, I must report such incident, or cause a report to be made, to the proper law enforcement agency or to Utah Department of Human Services.
Abuse of a Vulnerable Adult: If I have reasonable cause to suspect abandonment, abuse, neglect, or financial exploitation of a vulnerable adult, when there is reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect has occurred, I will report my suspicions.
Prenatal Exposure to Controlled Substances: If you disclose information regarding prenatal exposure to illegal drugs or alcohol in addition to misuse of prescribed medications, I will report this information to your State Department of Human Services.
Court Proceedings: If you are involved in a court preceding please inform me immediately. You and I will avoid discussing any details of the case until after it has settled.
Emergency: If you are involved in in a life-threatening emergency and I cannot ask your permission, I will share information if I believe you would have wanted me to do so, or if I believe it will be helpful to you.
Other uses and disclosures of information not covered by this notice or by the laws that apply to me will be made only with your written permission.
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OTHER RIGHTS
If you are unhappy with what is happening during our time together, I hope you will talk with me so that I can respond to your concerns. Such comments will be taken seriously and handled with care and respect. You may also request that I refer you to another professional and are free to end services at any time.
You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of our work and about my specific training and experience. You have the right to expect that I will not have social or sexual relationships with clients or with former clients.
