NAME OF ORGANIZATION
CONFIDENTIALITY POLICY FOR STAFF AND CONSULTANTS
In accordance with federal, state and local regulations concerning confidentiality of participant information, NAME OF ORGANIZATION ensures that all participant information, either verbal or recorded, shall be held confidential. Participant information consists of counseling observations, treatment plans, treatment accomplished, and whether the person is or was a participant. It is agency philosophy that the effectiveness of treatment provided depends in part upon a participant’s trust of the counselor and upon the participant’s freedom to reveal everything about his/her particular problem without fear of public disclosure.
Disclosure of information is appropriate in the following two categories:
1.Without the Consent of the Participant. In certain situations without the participant’s consent in accordance with the regulations (refer to B. “Release of Information Without Participant Consent” on the following page).
2.With the Consent of the Participant. If under 18, the minor and his/her parents, guardian or custodian where appropriate, e.g. if they are involved in the treatment and if they are aware their child is being seen by our agency. In some cases the youth does not want his/her parents to be aware of the fact that he/she is coming to our agency.
A.Participant Consent to Release of Information.
1)Short-Term Services. In cases where our only contact with the participant is via telephone and participant information needs disclosure (i.e. referral of participant to another agency), verbal permission must be obtained from the participant and the specific permission noted in the participant’s case record. This includes a participant that calls indicating that he/she desires to become a participant but never actually comes in.
2)Treatment Services. In cases where the participant has been seen in person by this office and participant information needs to be released, the participant must sign a consent form for the release of the information. The consent form shall include the following:
a)Name of the program making disclosures.
b)Duration of release, how long to be validly used, and authority (if any) to revoke.
c)Name of participant.
d)Name or title of person/organization to which disclosure is to be made.
e)Specific purpose or need for disclosure.
f)Extent and nature of information to be disclosed.
g)Date signed.
h)Signature of participant witnessed by a program employee. (See NAME OF ORGANIZATION’s Consent Form.)
B.Release of Information Without Participant Consent.
1)Confidential information may be released in a medical emergency to medical personnel.
2)Information may be subpoenaed by a court of law.
3)Cases of suspected child abuse/neglect must be reported to the Division of Social Services or to the Police.
4)Cases where a participant is committing a felony, is wanted by the law, or is known to be an escapee from a correctional facility or is otherwise evading his legal custodians, must be reported to the proper authorities. This agency cannot conceal or aid an offender known to have committed or to be committing a felony. Nor can the agency help such a participant avoid arrest.
5)Cases where a participant is feared to be in real physical health danger will be reported to the proper authorities.
6)Information may be disclosed within the agency among agency personnel having a need to know (i.e. a counselor-supervisor relationship).
7)NAME OF ORGANIZATION can release statistical information such as age, sex, and type of problem (i.e. for evaluative purposes, funding, etc.) if there is no other participant identifying information included and it would not be a disclosure of confidential information.
8)If information is released without a participant’s consent they will be notified when practical.
Breaching confidentiality unless as stated above, is grounds for immediate termination of employment with NAME OF ORGANIZATION and of a contract with NAME OF ORGANIZATION.
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SignatureDate
Confidentiality Agreement – page 1 of 2