CONFIDENTIALITY AND PRIVACY AGREEMENT - DFS Consulting

Psychological Counseling, Psychotherapy, Hypnotherapy, Life Coaching, Personal Development. Private Individual & Corporate Training, Seminars, Workshops & Employee Assistance Program (EAP)

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CONFIDENTIALITY AND PRIVACY AGREEMENT

NOTICE OF PRIVACY PRACTICES

Privacy is a significant concern for everyone who seeks services from our organization. Given the complexities of state laws and professional regulations, safeguarding your information is paramount. This notice outlines how your medical information may be used and disclosed, as well as how you can access this information. Please review this notice carefully to understand your privacy rights and our practices.

How We Handle Your Information

This section is crucial for you to understand so that you can make informed decisions for yourself and your family. We are also required to provide this information in compliance with privacy regulations, specifically the Data Privacy Act of 2012 (RA 10173).

Each time you visit or have consultations with our professionals, we collect information about you, including details regarding your physical and mental health. This may include information about your past, present, or future health conditions, the treatment or services you have received from us or other providers, and information related to payment for healthcare services.

The following types of information are included in your medical or healthcare record at our organization:

Personal History: Details about your childhood, education, work history, marital status, and personal background.
Reasons for Treatment: Information about your issues, complaints, symptoms, needs, and goals.
Diagnoses: Medical terms used to describe your problems or symptoms.
Treatment Plan: The proposed treatments and services deemed most beneficial for your care.
Progress Notes: Observations and notes made during each visit about your progress, our observations, and what you share with us.
Records from Other Providers: Information obtained from other professionals who have treated or evaluated you.
Psychological Test Scores: Results from any psychological assessments.
Medication Information: Details about medications you have taken or are currently taking.
Legal Matters: Relevant legal information, if applicable.

This list provides an overview, but additional information may also be included in your healthcare record. We use this information for various purposes, including:

Care Planning: To develop and implement your care and treatment plan.
Treatment Evaluation: To assess the effectiveness of the treatments provided.
Coordination with Other Professionals: When communicating with other healthcare providers involved in your care, such as your family doctor or the referring professional.
Quality Improvement: To enhance our services by evaluating the results and effectiveness of our work.

Understanding the contents and uses of your health record empowers you to make informed decisions regarding who has access to your information, and under what circumstances. While your health record is physically owned by the healthcare practitioner or facility that created it, the information within it belongs to you. You have the right to inspect, read, or review your health record. If you request a copy, we can provide one, though there may be a charge for copying and mailing, if applicable. In some exceptional cases, there may be restrictions on accessing certain parts of your record. If you identify any inaccuracies or omissions in your records, you have the right to request an amendment to include the correct information. Please note that while we strive to accommodate such requests, there may be rare instances where we are not required to make the changes.

Privacy and The Laws

State laws mandate that we maintain the privacy of your information. We will adhere to the guidelines outlined in this notice for as long as it is in effect. The organization complies with the Mental Health Act (RA 11036 of 2019) and the Data Privacy Act (RA 10173 of 2012). For a comprehensive overview of these regulations, please read the full document here: https://dfsconsultingph.com/ph-laws-mental-health/.

CONFIDENTIALITY IN TREATMENT

Professional ethics and state laws prohibit us from disclosing any information discussed in treatment to others without your explicit written consent. These regulations and ethical guidelines are designed to ensure and protect the confidentiality of therapy. However, there are specific circumstances under which the law requires us to disclose certain information. The limits of confidentiality are outlined in our “Notice of Privacy Practices.” Please refer to this notice for detailed information about these limitations and the circumstances under which disclosure may be mandated. If you have any questions or need further clarification, please do not hesitate to contact us.

Confidentiality and Disclosure Guidelines

Mandatory Disclosure for Safety and Welfare:

Imminent Danger: If there is a threat to your safety or the safety of others, we are legally required to disclose information to protect those at risk.

a. If you threaten serious harm to another person, we are obligated to take steps to protect that person and notify them of the threat.

b. If you make serious threats or engage in actions that pose a significant risk of harm to yourself, such as indicating a plan to commit suicide, we may need to seek hospitalization or contact a family member or another individual who can help ensure your safety. We will discuss the situation with you before taking any action, unless there is an urgent need to act immediately. In emergencies where your life or health is at risk and we cannot obtain your consent, we may share information with other professionals to protect you. We will attempt to secure your permission first and discuss the situation with you as soon as possible afterward.

c. If we have a professional judgment-based suspicion that a child (anyone under 18 years of age) is being or has been abused, we are required to report our suspicions to the relevant authorities or government agencies responsible for child abuse investigations. This requirement applies even if we do not have direct contact with the child in a professional capacity. We are also obligated to report suspected abuse if someone informs us of a child currently experiencing abuse.

Additional Confidentiality Considerations:

a. Professional Consultation: We may consult with other professionals regarding your treatment. These professionals are also bound by confidentiality standards. If your therapist is unavailable, another therapist may assist you, and relevant information about your treatment may be shared with them.

b. Record Keeping: We are required to maintain records of your treatment, which you have the right to review.

c. Legal Cases: In the event of legal proceedings, a judge may issue a court order to access your treatment records.

Email Communication:

We use email for scheduling, modifying appointments, and handling medical prescriptions or mental health certificates. Be aware that emails are logged by both your and our internet service providers. Although it is unlikely, these logs could be accessed by system administrators. Emails exchanged with your therapist become part of your legal record. Please avoid sending urgent information via email, as it may not be reviewed promptly.

Psychiatric Emergencies:

In case of a psychiatric emergency, we may refer you to another institution. By agreeing to this form, you authorize us to communicate with crisis evaluation units regarding your condition and potential recommendations for further treatment.

Other Points:

a. Session Recordings: Therapy sessions may be recorded with your consent, though this is rare.

b. Sharing Information: We will not disclose information about your treatment to anyone outside our organization without a signed release of records form.

c. Public Information: Information that you share publicly outside of therapy is not considered protected or confidential.

CONSENT TO TREATMENT

Welcome! We appreciate your trust and the opportunity to assist you. Please review the following information carefully before providing your agreement at the end. Should you have any questions or concerns, please do not hesitate to contact us.

Benefits and Outcomes of Mental Health Treatment

In addition to the benefits and positive outcomes associated with counseling, there may be some unanticipated effects. As counseling—whether individual or group therapy—involves addressing challenging issues, you may experience the following:

Increased focus and energy directed towards your issues.
The emergence of new emotions that you may not have previously experienced.
A shift in perspective that may be confusing as you see things in new or different ways.
Potential impacts on relationships as you explore interpersonal issues.

While these changes may be initially stressful, they can ultimately lead to greater self-understanding and more meaningful experiences.

To effectively meet the needs of as many clients as possible, our organization employs a short-term treatment model and offers a variety of treatment options, including group therapy, workshops, and individual sessions. Clinicians will assess your needs and use their professional judgment to determine the most suitable treatment modality and duration. If it is determined that longer-term services are needed or if an outside provider would be more appropriate, referrals will be made to other sources of assistance.

Psychiatrists and Medications

If deemed appropriate, you may be referred for a psychiatric evaluation with a psychiatrist. Medications can be beneficial for certain mental health conditions, particularly when they impact your ability to function or care for yourself. Should the psychiatrist recommend medications, they will discuss the following with you:

The potential benefits of the medication.
How the medication works.
Possible side effects and whether any bloodwork is needed to monitor for these effects.
Alternatives to the recommended medication, including the option of not using medications, along with the expected outcomes of these alternatives.
The medication’s dosage, frequency, and any potential drug interactions.
Special instructions for taking the medication.

You will then have the opportunity to decide whether to proceed with the recommended medication in addition to therapy or to continue with therapy alone. If you choose to take the medication, it is crucial to follow the prescribed instructions precisely.

Missed or Late Cancellation Appointment Policy

Cancellation / Rescheduling

A minimum of 15 hours’ notice is required to cancel or reschedule an appointment without incurring the full charge. Failure to provide this notice will result in a no-show fee being applied. This policy ensures that other clients have the opportunity to schedule sessions with their therapists and respects the professional’s reserved time. If you need to make any changes or have concerns regarding your appointment, please contact us promptly by replying to this email at ap**********@df*************.com or by sending a message via Viber at +639631699816.

Waiting Time

DFS gives a maximum 15-minute grace period for waiting time. Reminders via our booking software are being automatically sent to your email address 24 hours, 2 hours and 1 hour before your scheduled appointment. You may also be contacted by appointments if you are still not in your session for the past 5 minutes from scheduled time. If you still fail to attend your scheduled appointment without notification or do not cancel at least 15 hours in advance, it is considered a missed session and shall be billed at full rate. Again, please also respect the time of the Professional waiting for you.

Clients who have missed three sessions in a rolling three-month period will lose eligibility for counseling services and will not be rescheduled for another appointment for the remainder of the term, or if it occurs at the end of the quarter, will not be scheduled during the next term. In this case, the organization can assist the client in finding a referral in the community.

Informed Consent

This document is presented to the client before submitting their information and during appointment reminders. By reviewing this document, the client acknowledges that they have read and understood the points outlined and agree to abide by them. The client fully consents to comply with the conditions specified in this document. By continuing with the consultation, you provide your consent to proceed under the terms outlined in our agreement.