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To participate, please fill out the information below. Once we recieve & verify your information, we will send you a Zoom login code. We are excited to connect with you!
GUEST / VISITOR CONSENT TO MAINTAIN CLIENT PRIVACY AND CONFIDENTIALITY
Healing Springs Ranch (HSR) is a one of a kind residential treatment facility that offers a different approach to people who struggle with substance use. Our entire program and curriculum has been designed to help your loved one identify his/her core issue(s) that drive his/her addictive behaviors and related mental health symptoms. Often this process involves sharing painful and difficult past experiences. Clients learn the value of transparency, honesty, vulnerability and integrity. With this in mind, HSR has gone to great lengths to create a safe and supportive environment that is conducive to this kind of sharing and soul-searching experience.
One important variable that creates safety is consistency. Therefore, HSR has specific rules in place for all clients, alumni, staff, vendors and visitors. While it may seem like there are a lot of rules, please know that many variables must be considered with such a large, rural, and co-ed campus.
GUEST/VISITOR/ALUMNUS UNDERSTANDS that HSR will not tolerate any contraband being brought in and given to any HSR clients. Contraband is defined as any substance, device or item that can be used in a self-harming manner (i.e. guns, knives, razors, drugs, alcohol).
GUEST/VISITOR/ALUMNUS UNDERSTANDS that HSR is a smoke-free/tobacco-free facility. No tobacco products are to be given to ANY of the clients for ANY REASON (i.e. cigarettes, dip, chewing tobacco, cigars, e-cig's etc.)
GUEST/VISITOR/ALUMNUS UNDERSTANDS and agrees to adhere to the HSR policy regarding food NOT being brought into the facility.
GUEST/VISITOR/ALUMNUS UNDERSTANDS and agrees NOT to take pictures or record anything while onsite or participating remotely or virtually in any program, event, or activity.
GUEST/VISITOR/ALUMNUS UNDERSTANDS that failure to comply with the rules and requests of HSR will result in the loss of visitation/participation rights and privileges. If you have any questions or concerns please share with the clinician conducting the orientation.
FOR THE PURPOSES OF THIS CONSENT TO MAINTAIN CLIENT PRIVACY AND CONFIDENTIALITY, the term “guest” or “visitor” shall include anyone joining virtually or anyone who is on the premises of Healing Springs LLC; dba Healing Springs Ranch (“HSR”) outside of its employees, contractors or designated representatives.
GUEST/VISITOR ACKNOWLEDGES that Healing Springs, LLC, dba Healing Springs Ranch (“HSR”) is a Texas Residential Health Care Provider Licensed by the Texas Department of State Health Services and subject to the Health Insurance Portability and Accountability Act (45 CFR Parts 160 and 164 ("HIPAA"), HIPAA governs the confidentiality of client personally identifiable information, and HSR strictly adheres to these provisions. Healing Springs requires that it's employees, contractors, agents, representatives as well as visitors and guests comply with HIPAA.
GUEST/VISITOR ACKNOWLEDGES AND AGREES that if he/she, in the course of his/her visit on the premises or participation in an activity or program onsite, remote or virtually is exposed to, intentionally, if authorized by law, or unintentionally, to client personally identifiable information, which includes the knowledge that any such client is undergoing treatment at HSR guest/visitor must hold such information in strict confidence. If such exposure is unintentional guest/visitor agrees to inform HSR management of any such receipt of personally identifiable information so that HSR may take the necessary steps to rectify any potential breach of client confidentiality and ensure that client privacy is maintained. Guest/visitor acknowledges that clients could be irreparably harmed by any breach of client personally identifiable information, and that HSR may pursue all remedies available should guest/visitor share such information in violation of HIPAA or otherwise, whether on the HSR premises or after guest/visitor leaves the premises.