Statement of Client Rights and Responsibilities

 

ACCESS TO INFORMATION
You have access to your information that a therapist deems would not by its disclosure injure you in some way. Access for review is available by written request. Access to copies of your information requires a written request and payment of a copy fee. If you have a legal guardian, your legal guardian may have access to your information.

​

PARTNER NOTIFICATION
The Florida Department of Health provides free and confidential partner notification to those who may have been exposed to HIV or other sexually transmitted infections (STI). You simply give them the contact information of the individual who has been exposed and they do the rest. The notified individual gets the opportunity to be tested and receive early treatment, possibly avoiding life threatening conditions from untreated HIV or other STIs. Want to use a confidential e-mail service to notify partner’s who’ve been exposed? www.inspot.org/florida

​

Pediatric & Family Health and Wellness Center CONFIDENTIALITY AGREEMENT

Who You See Here; What You Hear Here; When You Leave Here; Let it Stay Here!
Confidentiality entails the responsibility to safeguard clients from unauthorized disclosures of information. As you are aware, clinicians are bound by strong ethical and legal rules regarding confidentiality. Your issues will be held confidential within the clinical staff of the Pediatric & Family Health and Wellness Center with the following exceptions: (1) You are a threat to yourself or to others (for example, you are suicidal or homicidal), (2) Your clinician knows or suspects you are abusing a minor child, or vulnerable adult, (3) This agency, or a representative thereof, is under court order, such as a subpoena or deposition.

​

As a client of the Pediatric & Family Health and Wellness Center, you are expected to abide by certain rules of confidentiality. Clients must feel safe in knowing that their statements and presence as members of the Pediatric & Family Health and Wellness Center will not be disclosed except as expressed herein. The foundation of confidentiality allows each client to fully explore his or hers own feelings in a safe environment without fear of retribution or negative consequences upon returning to the world outside of the Pediatric & Family Health and Wellness Center. Some clients do not want family members or other friends to know that they are receiving services from the Pediatric & Family Health and Wellness Center. We must respect those wishes.

​

You are expected to protect the confidentiality of other Pediatric & Family Health and Wellness Center clients. This means, specifically, that you are not to disclose the identity of any client outside of the Pediatric & Family Health and Wellness Center. You are not to discuss anything that is learned about another client at the Pediatric & Family Health and Wellness Center. These rules are rigidly enforced to protect you and other clients of the Pediatric & Family Health and Wellness Center.

​

LIMITS TO YOUR CONFIDENTIALITY
It is important for you to know that there are limits to the confidentiality of your information. This means that access to information in your case file is possible when required by law and/or regulation. Examples of these limits to confidentiality are as follows:

​

• Your case file may be subject to review when ordered by a judge.

• If we believe you intend to harm yourself or someone else, it is our ethical and professional duty to inform others, as the circumstance requires.

• In situations of suspected child or vulnerable adult abuse, it is required that we report this to the appropriate authorities.

• Other professionals associated with your care may have access to information on record in your case file without your written consent.

• During a medical emergency, we will disclose information that will assist emergency personnel in treatment.

• You may request in writing to see your record.

• You may consent in writing to disclose parts of your record to someone else.

• Your information may be disclosed to law enforcement when a crime is committed on the premises or against a member of staff.

• Payers have access to your information for the purpose of oversight, quality review, utilization review and public health reporting.

• You may be seen in group therapy. If so, you and every other member of the group will be told that anything discussed is private. This includes the names of group members of any problems they discussed in group. This is not to be talked about with anyone outside the group. Confidentiality will exist only to the extent that each patient trusts and respects every other member of the group. Violation of this confidentiality is grounds for dismissal from the program.

STATEMENT OF CLIENT RIGHTS
As a client of the Pediatric & Family Health and Wellness Center, you have many rights. We always want to make sure you are valued and served in the most professional manner. Here’s what you can expect:

​

1. I have the right to respectful treatment by staff.

2. I have the right to services, provided without discrimination because of race, age, religion, nationality, origin, sex, sexual orientation, disability or economic status.

3. I have the right to confidentiality (privacy) except when there is danger to others or myself.

4. I have the right to assignment to a professional clinician.

5. I have the right to actively participate in the development and review of an individualized treatment plan. This includes the right to know and meet with the professional staff members responsible for my care, to know their professional qualification and to know their staff person.

6. I have the right to the least restrictive type of treatment that can meet my needs.

7. I have the right to pursue a complaint through the written grievance procedure provided at intake.

8. I have the right to understand the services that the Pediatric & Family Health and Wellness Center provides including my rights and responsibilities as a client before receiving services from the Pediatric & Family Health and Wellness Center.

9. I have the right to be referred to appropriate services and agencies when my needs are beyond what can be provided at the Pediatric & Family Health and Wellness Center.

10. I have the right to give informed consent or to refuse treatment and to be advised of the consequences of such refusal.

11. I have the right to a humane and safe environment giving me reasonable protection from harm and appropriate privacy with regard to my personal needs.

12. I have the right to request a therapist change (if receiving individual therapy). I understand that changes of therapist will be made only after consultation with the Psycho-social Services Manager and the therapist assigned to me.

 

STATEMENT OF CLIENT RESPONSIBILITIES
As a client of the Pediatric & Family Health and Wellness Center, you have many responsibilities too. We always want to make sure you understand your responsibilities and accept the credit for your success in treatment. Here’s what we expect from you:

​

1. I am responsible for maintaining the confidentiality of other clients.

2. I am responsible for following the Supported HIV Home Testing Program Rules.

3. I am responsible for the grievance procedure as outlined in the Client Grievance Procedure for any problem or concern.

4. I am responsible for informing staff at the agencies from which I receive HIV prevention services, that I am also receiving HIV prevention services from the Pediatric & Family Health and Wellness Center. I understand that coordination of services between agencies is to my benefit.

5. I will treat all Pediatric & Family Health and Wellness Center staff, volunteers, and clients respectfully. I will not be verbally or physically abusive.

6. I am responsible for following the risk reduction plan that I have developed with my counselor.

7. I am responsible for keeping all scheduled appointments. I will give 24 hours notice if I need to miss an appointment and reschedule the appointment with my counselor.

8. I will attempt to remain drug and alcohol free while on the premises of the Pediatric & Family Health and Wellness Center.

9. I am responsible for providing my counselor with an update of any changes in my status (physical, financial, emotional).

10. I am responsible for providing my own transportation whenever possible. If unable to provide my own transportation; I will contact my testing counselor for available resources.