, hereby acknowledge that I have received this Notice of Privacy Practices, with an effective date of June 1, 2013. Within these guidelines, at Beautiful Minds Medical, specifically there are five instances in which your right to privacy will be set aside:
A. Your therapist is required by law to report if any participant in therapy, specifically or vaguely disclose(s) information possibly indicating current or past abuse or neglect of a child, dependent adult, or elder.
B. Your therapist must notify the local authorities and/or the person(s) in danger if your therapist believes, from information that you disclose, that you are of danger to yourself or to someone else.
C. During court proceedings, the Judge’s ruling supersedes your right to confidentiality. The attorney may subpoena your records, take your therapist’s deposition, have your therapist appear in court, or all three. Your therapist must break confidentiality if the Judge makes such an order.
And, only if in the Intensive Outpatient Program (IOP):
A. Beautiful Minds Medical works within a Treatment Team model to provide an integrated approach to the overall needs of the client. In accordance with this model, information and behavior during group and/or individual and/or family session may be shared with the Beautiful Minds Medical Treatment Team (i.e., Psychiatrist, Nurse Practitioner, and Therapist). The information is shared for the purpose of treatment planning to best meet your therapeutic needs.
If I am at risk of hurting myself or others while away from the program, I will call: