CONFIDENTIALITY: The discussions between the client and the therapist as well as any records are confidential with the exceptions noted below and in the Notice of Privacy Practices provided to them. No information will be released without the client's written consent unless mandated by law. Possible exceptions to confidentiality include but are not limited to the following: abuse of any other person, sexual exploitation, AIDS/HIV infection and possible transmission, criminal prosecutions, child custody cases, lawsuits in which the mental health of a party is an issue, situations where the therapist has a duty to disclose, or where, in the therapist’s judgment, it is necessary to warn or disclose, a negligence suit brought by the client against the therapist, or the filing of a complaint with the licensing or certifying board. If the client has any questions regarding confidentiality, the client will bring them to the attention of the therapist. By signing this Information and Consent Form, The client consents to the undersigned therapist to share confidential information with all persons mandated by law and with the agency that referred the client and the insurance carrier responsible for providing the client mental health care services and payment for those services. The client also releases and holds harmless the undersigned therapist and Masquigon Integrative Behavioral Health from any departure from the right of confidentiality that may result.

 

PRIVACY: Masquigon Integrative Therapy follows all privacy practices mandated by HIPAA (Health Insurance Portability and Accountability Act of 1996). This means that the client's information will be utilized for the purposes of treatment, obtaining payment, and supporting the day-to-day healthcare operations of Masquigon Integrative Behavioral Health. Information may also be shared with the appropriate entities to support government audits and inspections, law-enforcement investigations, and to comply with mandated reports as mandated by law. The client's information may also be shared among staff for scheduling needs.

 

TELEHEALTH: The laws protecting the client's medical information also apply to telehealth. The client will need to utilize the client portal to engage in telehealth services which require the use of a smartphone device with a cellular connection or access to the internet. The appointment may be disturbed by poor connection or other technical difficulties which may delay the client's treatment. Security protocols could fail and cause a breach of privacy of personal medical information, although rare. The client may not operate a vehicle during the session and must remain in a private confidential space while in session to maintain the client's confidentiality. The client will alert the clinician if they choose not to participate in telehealth services.

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CLIENT RIGHTS: The client may request a report outlining the use of the client's information at any time after which they will be provided a summary by the client's provider. Unlimited access to the client's information (e.g., session notes) may cause emotional distress and disrupt the therapeutic relationship. Therefore, the client is not given access to their treatment notes unless the provider provides the client access or the client obtains a court order after which the clinician has thirty days to respond.

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DUTY TO WARN/DUTY TO PROTECT: If the client's therapist believes that they are in physical or emotional danger or they are a danger to another human being, the therapist is required by law to contact medical or law enforcement personnel to prevent harm to another person or the client, and may contact the person in danger.

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