By law and professional ethics, what is shared with a therapist remains confidential. If you consent in writing that information be shared with a third party, this modifies confidentiality per your consent in those situations in accordance to applicable laws and statutes. To share information with a third party, I will ask you to sign and “release of information form” (ROI). The ROI will be maintained in your clinical file or electronic health record (EHR).
There are exceptions to the confidentiality. I am mandated by the State of Michigan (which has issued my license to practice as a Licensed Professional Counselor) to report to Child Protective Services if I either suspect or receive a disclosure of child abuse and/or neglect. I am also mandated to report to Adult Protective Services if I suspect or receive a disclosure of vulnerable adult abuse and/or neglect. I am also mandated to report imminent risks of danger for people regardless of age. If you have any questions, I am eager to clarify. PRIOR TO DISCLOSING, PLEASE FEEL FREE TO ASK ABOUT THIS MANDATE IF THAT IS HELPFUL TO YOU. IF YOU ARE SEEKING SERVICES AS AN ADULT ABOUT CHILDHOOD ABUSE, PLEASE ASK ME ABOUT THIS MANDATE IF YOU HAVE ANY CONCERNS.
The following statements will serve as notice to you in intake forms which you will be asked to sign upon consent for treatment. You will be informed of your Health Insurance and Portability and Accountability Act (HIPAA) rights and practices within my practice to include:
>My protected health information may be used and disclosed to carry out treatment, payment or health care options.
>I have the right to review the PHI Form prior to signing consent to release information.
>The terms of the PHI Form may change and I may request a revised notice.
>I have the right to request restrictions on uses and disclosures of protected health information for treatment, payment and healthcare operations, but that my provider is not required to agree to the restrictions if they would impair her ability to provide necessary services.
>Any restrictions agreed upon by the provider will be binding.
>I may revoke consent in writing, except to the extent that has already been cited based on my previous consent.