Confidentiality Agreement (HIPPA)

Confidentiality is an increasingly complex issue. In most situations, we can only release information about client treatment to others if the client signs a written Authorization form that meets certain legal requirements imposed by HIPPA (Health Insurance Portability and Accountability Act, which went into effect on April 14, 2003). However, some situations, described in the bullet points below, require only that clients provide written advance consent. Your signature on this Agreement provides consent for the following situations:

  • It may occasionally be helpful to consult other health and mental health professionals about a case, to provide clients with the best service possible. During a consultation, every effort is made to avoid revealing client’s identity. The other professionals are also legally bound to keep the information confidential. Generally, a client will not be told about these consultations unless it is deemed important to the work we are doing together.
  • If a government agency is requesting the information for health oversight activities, we may be required to provide it to them.
  • If a client files a complaint or lawsuit, it may be necessary to disclose relevant information about you, as the client, for our defense.
  • If a third party is being compensated for providing treatment to you as a result of your having filed a worker’s compensation claim upon appropriate request, we will provide information necessary for utilization review purposes.

In addition, a client’s insurance company, if using one, requires a diagnosis be given in order to reimburse you for services rendered. They may also request additional information, and this will be provided as needed. Though all insurance companies claim to keep such information confidential, we have no control over what they do with it once it is in their hands. By signing this Agreement, you agree that I can provide requested information to your carrier.

If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the counselor-patient privilege law. We cannot provide any information without either your written authorization or a court order.

There are three additional situations in which I am legally obligated to take action. These rare situations only occur when I believe others are in harm’s way as a result of your actions. If this happens, I may have to reveal some information about your treatment. If such a situation arises, every effort will be made to disclose it with you before taking any action and disclosure will be limited to only what is necessary.

  1. If there is reasonable cause to suspect you of child abuse or neglect, the law requires that a report be filed with the Family Independence Agency. Once such a report is filed, it may be necessary to provide additional information.
  2. If there is reasonable cause to suspect the “criminal abuse” of an adult, it must be reported to the police. Once such a report is filed, it may be necessary to provide additional information.
  3. If you communicate a threat of physical violence against a reasonably identifiable third person and I judge you to have the apparent intent and ability to carry out that threat in the foreseeable future, I may have to disclose information in order to take protective action. These actions may include notifying the potential victim, contacting the county Department of Social Services, the police, and/or seeking hospitalization for you.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. In situations where specific advice is required, formal legal advice may be needed from an attorney.