POLICY AND PROCEDURE

House of New Hope

POLICY: CRM-806

TITLE: Release of Client Information Procedure

EFFECTIVE DATE: January 1, 2008 AUTHORIZED BY: Board of Trustees

REVISION DATE:

ODMH 5122-27-08

1.  HONH will not convey to any person outside the agency that a person attends or receives mental health services from HONH or disclose any information regarding participation in such services unless:

A.  The client signs a release of information;

B.  There is a court subpoena or court order for such information;

C.  The disclosure is made to medical personnel in a medical emergency;

D.  The disclosure is made to secure mental health intervention in the event of a psychiatric emergency in which the life of the client is at risk;

E.  The disclosure is made to qualified personnel, with client signed permission, for research or evaluation purposes; or

F.  The disclosure is made as a result of an audit, in which confidentiality expectations extend to the auditing body;

G.  The clients states a specific threat to harm him/herself or others;

H.  Knowledge of abuse or neglect of a child requires mandatory reporting to state and/or local authorities;

I.  In the case of minors, permission to release information must be signed by the parent/legal guardian.

2.  Information is only to be released when an Authorization of Release of Information form is signed by the client and/or legal guardian and witnessed by program staff. Copies of signed and completed Authorization of Releases of Information will be made available to consumers upon request and maintained in the client record. A log will be maintained in each ICR of all non-routine disclosures.

3.  A release of information form will contain, but not be limited to:

A.  Name of agency/program making disclosure;

B.  Name of agency/program and/or person to which the disclosure is made;

C.  Name of client;

D.  Date of birth and/or social security number of client;

E.  Purpose for disclosure;

F.  Kind/amount of information to be disclosed;

G.  Expiration date which will reflect the date, event or condition upon which the authorization shall expire, note to exceed six months from the date of its completion, unless documentation reflects that the client agrees to a longer authorization period;

H.  The dated signature of the client or, as appropriate, a legally authorized agent (parent/legal guardian) and the agent’s relationship to the client.

I.  A statement notifying the client of his/her right to shorten or lengthen the authorization period;

J.  Statement that the client’s consent is subject to revocation at any time except to the extent that the program/person has already acted upon it;

K.  A statement of prohibition of re-disclosure.

4.  As needed, when requests seek special or unusual information about a consumer as might occur from public officials, law enforcement bodies, legal counsel, family members, etc., and in the event of a court subpoena for specific information, advice should be solicited from the agency’s general counsel to assure such requests meet the conditions of legal release per confidentiality of records requirements.

5.  The records released include information of an HIV-related diagnosis or test result, the following statement applies:

This information has been disclosed to you from confidential records protected from disclosure

by state law. You will make no further disclosure of this information without the specific,

written, and informed release of the individual to who it pertains, or as otherwise permitted

by state law. A general authorization for the release of medical or other information is NOT

sufficient for the purposes of the release of HIV test results or diagnoses.

1.  All releases of information shall conform to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

2.  In the event of the death of a child in placement, HONH will comply in full as required in ORC Sections 307.627, 2151.421, and 4731.22.

Release of Client Information Procedure Page 1