Release Of Information Consent Form Psychology In Massachusetts

State:
Multi-State
Control #:
US-00459
Format:
Word; 
Rich Text
Instant download

Description

This Consent to Release of Financial Information authorizes all banks, financial institutions, businesses, employers, credit reporting agencies and any other businesses to which this person is indebted or have assets located, to provide information concerning his/her finances and assets, without liability, to the person or entity named in this Consent form. This form is applicable in any state.

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FAQ

Exceptions to the Duty of Confidentiality Waiver. A person who confides in a professional can waive the protection of professional secrecy. In Case of Danger. Committing a Crime. Infectious Diseases. Inspection and Investigation by Professional Orders. Search for the Truth. Protection of Children.

As in the Tarasoff ruling, the statute notes that the principle of duty to warn is an exception to the general principle that a social worker shall not "disclose any information about a client acquired from or revealed in the course of or in connection with the performance of the social worker's professional services." ...

A patient must understand the following for the consent to count as informed: A description of the procedure. A list of the potential dangers or risks of the procedure. A description of possible positive outcomes.

The only times a psychologist would break confidentiality are in the event of threats of harm to self or other; reports that a child (under 18 years of age) or an elder (60 years and older) is being abused or neglected in some way; or if there is a subpoena or court order.

When there is an indication of abuse of a child, dependent adult or elderly adult. If you become gravely disabled. If information is required by a court subpoena or court order.

That said: In rare and serious cases, you may have an ethical and legal obligation to break client confidentiality. Mandatory reporting laws, or mandated reporting, require therapists to report to authorities when a person is being harmed or is in danger of being harmed.

In the case of minor children, parents must provide consent for treatment. In the case of shared or joint legal custody by divorced parents, the consent of one parent is required to proceed; however, the other parent must not state a clear objection.

Massachusetts law (Chapter 112) and Federal law (45 CFR; HIPAA, 1996) require that you are advised regarding how personal information about you may be used and disclosed and how you can get access to this information.

Minors aged 16 or 17 may consent to admission at a mental health treatment facility. Whose consent is required for minors to receive emergency medical treatment? DSS: Department of Social Services, the Massachusetts agency charged with preventing child abuse and neglect.

Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.

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Release Of Information Consent Form Psychology In Massachusetts