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Confidentiality & Release of Information Form

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Counseling and Human Development Statement of Confidentiality

Peonies in front of Dick's HouseThe Office of Counseling and Human Development (CHD) is dedicated to providing high quality health care. We maintain a confidentiality policy in which privacy is respected and better health care is promoted. An important way of insuring confidentiality is to provide patients/clients with detailed information on CHD's policy on confidentiality and the New Hampshire law on privileged communication between patients/clients and a mental health professional. In addition, a copy of the Mental Health Bill of Rights is posted in our waiting area. CHD has made copies available in the waiting room.

Mental health records are confidential. However, there are exceptions to maintaining strict confidentiality in that the law requires mental health providers to share information in specific circumstances to protect the health and safety of patients/clients or others. In addition, there are specific circumstances (such as emergencies or on-call matters) in which CHD mental health providers may give or seek information from previous, current or subsequent providers to enable coordination of care in the best interest of the patient/client.

It is important for patients/clients to know that New Hampshire general laws outline a protected relationship between mental health professionals and clients. This privileged relationship means that clinicians may not reveal or be compelled by law to reveal any communication, observation, test result or other information gained as a result of the treatment relationship. Information conveyed to Counseling and Human Development by someone other than our client is not considered confidential and may be shared with our client. Privileged communication between patient/client and therapist may be waived by a judge in child custody adoption cases, in law suits where mental condition is an important consideration, and in criminal law suits. Federal law and professional ethical guidelines require us to inform patients/clients that sexual contact between a therapist and patient/client is a serious violation of professional practice. Finally, if psychological issues are substantially affecting ability to learn, patients/clients may be eligible to register under the Americans with Disabilities Act for psychiatric disability status and academic accommodations through the Disabilities Office.

In attempts to provide our clients with a continuum of high level care, there may be times when the CHD staff will need to contact patients/clients or respond to patients/clients via electronic mail, voice mail, facsimile machine, cellular phone and/or answering machine, unless instructed otherwise. It is important to realize there is the potential that these messages could be inadvertently received or overheard by an unintended third party.

Although counseling records are maintained separately from the general health record, entries are made in our medical record at the Dartmouth College Health Service for coordinated health care purposes. They include: 1) date of visits and the name of mental health provider; and 2) psychotropic medication prescription. Detailed records for emergency counseling visits which occur at the Dartmouth College Health Service and inpatient admissions at the Dartmouth College Health Service for emotional reasons are filed separately from the general health record.

The office is open from 8:00 a.m. to 4:30 p.m. We can be reached at 646-9442. Emergency services are available 24 hours every day of the year. Clinical evaluations, medication evaluations, short term counseling, group therapy and emergency evaluations are provided at no cost.

If there are any questions on confidentiality, procedures or the bill of rights, please bring them to the attention of your primary mental health provider. Counseling and Human Development encourages patients/clients to help us maintain high quality care by active participation.

Last Updated: 10/2/08