The Hemophilia Foundation of Michigan (HFM) is honored to offer this patient support group. Thank you for attending. Please review the below information and sign your consent for participation.
1. Confidentiality:
You may choose to share your medical information or diagnosis in this group. Understand that this is not mandatory in order to participate in this group. HFM respects your right to privacy and honors HIPAA law; however, other group participants are not bound by HIPAA and HFM cannot guarantee that information you share in the group will be kept confidential by other group members. It is important for everyone participating in this group to respect the confidentiality of others. A general rule of thumb is: If it’s not your story then it’s not yours to tell. Please do not take the stories and personal information outside of this group session. If confidentiality is a concern by any participant, please notify the facilitator of the concerns so that proper action can be taken.
2. Respect:
There are many different types of individuals that may choose to attend this group. We do not discriminate on the basis of race, ethnicity, national origin, color, age, gender, gender identity, sexual orientation, religion, disability or any other protected class. There are many different opinions that might be shared and each individual has their own specific story, journey and perspective. Please be respectful of all opinions. Also, be mindful of how much you share so that we can respect the time and feelings of everyone in the group.
3. Attendance:
It is important to build rapport with your peers in a supportive group setting. The more you attend the groups, the stronger your relationships will be. Please attempt to attend as many groups as possible.
4. Mental Health:
Your mental health is important to us. If you ever feel the need for additional support please contact your health care provider. Likewise, if we observe that you could benefit from additional support, we will approach you. There are some occasions when sharing in an open setting is difficult or not a good fit.
5. Video Conferencing:
Video Conferencing (VC) is a real-time interactive audio and visual technology that enables our clinicians to provide group services remotely. The VC system we use meets HIPAA standards of encryption and privacy, but we cannot always guarantee privacy. Although VC may be used when the clinician or staff and members are in different locations, there are certain licensure restrictions that may apply and limit sessions to the state in which a clinician is licensed.
Group facilitators will discuss additional clinical risks and discomfort that may be associated with conducting group sessions over VC telehealth, as well as the logistics associated with virtual group sessions, at the beginning of the group session.
6. Mandatory reporting:
We, as healthcare providers and social workers/ therapists, are mandatory reporters. This means that if you share information that supports abuse, neglect, or exploitation of a child or adult we must report this to Protective Services Central Intake (855-444-3911). This is the law and we must abide by this law. In addition, if you share information that indicates there is a substantial probability of harm to you or another individual, we may disclose this information to a provider of mental health services or other health services or a public agency.