Confidentiality, Privacy & Rights
Private Mental Health Information
In accordance with the Illinois Student Optional Disclosure of Private Mental Health Act (the “Act”, P.A. 99-278), a student’s mental health information is considered private and will
not be released to a third party without that student’s prior written consent, unless
otherwise provided by other state or federal laws. Please read the Administrative Procedure in its entirety.
Student Optional Disclosure of Private Mental Health Information
In accordance with the Illinois Student Optional Disclosure of Private Mental Health
Act (the “Act”, P.A. 99-278), a student’s mental health information is considered
private and will not be released to a third party without that student’s prior written
consent, unless otherwise provided by other state or federal laws. Please read the
Administrative Procedure in its entirety.
Disclosure Form
Student Rights & Confidentiality
If you have any questions about confidentiality, I will gladly discuss them with you.
The purpose of this confidentiality statement is to enhance the therapeutic relationship
by ensuring and allowing you to understand the boundaries of information that you
can comfortably and confidentially share in therapy.
Student and client will be sued interchangeably in this document and has the same
meaning, "an enrolled student that is receiving or received in the past, any form
of counseling provided by a licensed counselor located in CSU Counseling center. means
that I have a responsibility to safeguard the information obtained during counseling.
All identifying information about your assessment and treatment is kept confidential,
except as mandated by law. You must sign a release of information before any information
about you is given to anyone, except as mandated by law, which is outlined further
below. Any communication or discussion between us is confidential. This means that
I will not discuss your case orally or in writing without your expressed written permission.
All interactions which take place in the setting of counseling are considered confidential.
This includes requests by telephone, all interactions with me, any scheduling or appointment
notes, all session content records and any progress notes that I take during your
sessions.
I will not verify that you are a student receiving counseling services from the CSU
Counseling Center. I prefer not to leave messages on my client’s voicemail. You may
choose to give me permission in writing to release any or specific information about
you to any person or agency that you designate. The law protects the privacy of communication
between us. In most situations, I can only release information about your treatment
to others if you sign a written Authorization form that meets certain legal requirements
imposed by HIPPA.
I may occasionally find it helpful to consult with other health and mental health
professionals about a case. During such consultation, I make every effort to avoid
revealing the identity of you, the client. The other professionals are also legally
bound to keep any information shared confidential. I work with other mental health
professionals in the counseling center, and I may eventually employ administrative
staff.
I may need to share protected information with individuals for clinical purposes.
All mental health professionals are bound by the same rules of confidentiality, and
we are all responsible for practicing professional codes of ethics. All counseling
team members have been given training about protecting your privacy and have agreed
not to release any information outside of the practice without the permission of a
professional staff member.
Limits of Confidentiality
Confidentiality is extremely important to our counseling relationship. What we discuss
in therapy will not be passed on. However, there are circumstances in which I have
an ethical and legal obligation to break confidentiality. These circumstances include
if:
- there is a reason to believe there is an occurrence of child, elder, or dependent
adult abuse or neglect, including being impaired while caring for a child or vulnerable
adult.
- there is reason to believe that you have serious intent to end your life, and/or if
you intend to harm yourself, someone else, or property by a violent act you may commit.
- you introduce your emotional condition into a legal proceeding.