• Limits of Confidentiality

  • Contents of all therapy sessions are considered to be confidential. Both verbal information and written
    records about a client cannot be shared with another party without the written consent of the client or
    the client’s legal guardian. Noted exceptions are as follows:
    _______________________________________________________________________________________________________________________

    Duty to Warn and Protect

    When a client discloses intentions or a plan to harm another person, the mental health professional is required to
    warn the intended victim and report this information to legal authorities. In cases in which the client discloses or
    implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable
    attempts to notify the family of the client.

    Abuse of Children and Vulnerable Adults

    If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child
    (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the mental health professional is
    required to report this information to the appropriate social service and/or legal authorities.

    Prenatal Exposure to Controlled Substances

    Mental Health care professionals are required to report admitted prenatal exposure to controlled substances that
    are potentially harmful.

    Minors/Guardianship

    Parents or legal guardians of non-emancipated minor clients have the right to access the clients’ records.

    Insurance Providers (when applicable)


    Insurance companies and other third-party payers are given information that they request regarding services to
    clients.

    Information that may be requested includes the type of services, dates/times of services, diagnosis, treatment plan,
    and description of impairment, the progress of therapy, case notes, and summaries.

    I agree to the above limits of confidentiality and understand their meanings and ramifications.

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