Release of Information/Confidentiality: Sessions are protected by confidentiality, which means that information about the Client cannot be given to anyone without express consent (in writing Our “Authorization Form” must be completed if we need to disclose information to the client’s physician, treatment center, or insurance carrier.) Client information may be disclosed within the Total Health Concepts, LLC counseling and supervision staff meetings. This practice is beneficial for the client(s), counselors and therapists to address all client needs utilizing standard treatment protocol and is in line with ethical guidelines and best practices regarding supervision and consultation with the American Counseling Association and the National Association of Social Workers. All THC staff meetings are held in a confidential setting.
The Client understands that there are limits to confidentiality:
To prevent a serious and imminent threat to the health or safety of yourself, another person, or the public Child abuse, or neglect or elder abuse is suspected If there is an order from the court to subpoena confidential information.
The Client understands that communication by E-mail may not be secure and that archives of E-mail communications may be subject to electronic interception or may be kept by third parties (such as ISPs) and be subject to court orders. Please review and sign the information regarding the Notice of Privacy Practices related to the Health Insurance Portability and Accountability Act (HIPPA Form) located on our website.
Emergencies: In case of mental health emergency, call 911, or go to the nearest hospital emergency room, or call your local community mental health center’s 24-hour emergency number.
Online psychotherapy, also known as telemental health services ("telehealth"), involves a therapist or counselor providing psychological counseling and support over the Internet through email, video conferencing, online chat, or phone calls.
The information may be used for diagnosis, therapy, follow-up and/or education.
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data, and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.
• Improved access to mental health services by enabling the client to remain in his/her home or other remote site.
• Mental health services are more accessible and convenient—increasing mental health treatment outcomes.
• More efficient evaluation and continuity of mental health services and necessary to protect the health of the client and therapist(s) during the Covid-19 pandemic situation.
There are potential risks associated with the use of telehealth services. These risks include, but may not be limited to:
• In rare cases, information transmitted may not be sufficient to allow for appropriate decision-making by the counselor/therapist;
• Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment;
• In very rare instances, security protocols could fail, causing a breach of privacy of personal information.
By signing this form, I understand the following:
1. I understand the laws that protect privacy and the confidentiality of information also apply to telehealth services, and no information obtained in the use of this service which identifies me will be disclosed to researchers or other entities without my consent.
2. I understand I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment.
3. I understand I have the right to inspect all information obtained and recorded in the course of a telehealth session, and I may receive copies of this information.
4. I understand that a variety of alternative methods of therapeutic care may be available to me, and that I may choose one or more of these at any time. My counselor/therapist has/will explain the alternatives to my satisfaction.
5. I understand telehealth services may involve electronic communication of my personal information.
6. I understand I may expect benefits from the use of telehealth services, but that no results can be guaranteed or assured.
Patient Consent To The Use of Telehealth Services:
I have read and understand the information provided above regarding telehealth. I have discussed it with administration (and/or counselor/therapist), and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my psychotherapeutic care.
I hereby authorize Total Health Concepts, LLC to use telehealth in the course of my diagnosis, evaluation, and treatment.