Common use of Clinician Clause in Contracts

Clinician. You may contact your graduate clinician or their supervisor through email at xxxxxxx@xxxxxx.xxx or by phone at 000-000-0000. Due to your graduate clinician’s work and class schedule, the graduate clinician will often not be immediately available by email or phone. Communications with graduate clinicians may change based on University operations. When AUPSC operations are remote, you may leave a message on the AUPSC answering machine but it may not be returned immediately. Email is checked during business hours Monday through Friday, except during Auburn University holidays. At other times, you can send an email and your graduate clinician will reach out as soon as possible. If you are difficult to reach, please inform your graduate clinician of times when you will be available. AUPSC is not available for emergent services. In case of an emergency that occurs when AUPSC is closed (from 7 pm until 8 am Monday through Thursday and from 5 pm Friday until 8 am Monday) please call the nearest emergency room and ask for the on call psychiatric nurse. The number for the East Alabama Medical Center is (000) 000-0000. Because AUPSC is a university clinic, staffed by graduate student clinicians, there are times when your graduate clinician might not be available for an extended time, such as during a school break. These breaks occur between semesters and typically last for one week, except for the winter holiday, which lasts for two weeks. If you or your graduate clinician determines that you need continuous services that cannot be provided at AUPSC, your graduate clinician will provide you with a referral to an agency or therapist that can provide the services you need. LIMITS ON CONFIDENTIALITY The law protects the privacy of all communications between a client and a psychologist. In most situations, your graduate clinician and/or the clinical supervisor can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • Because AUPSC is a training clinic, and your therapist will be a graduate clinician, your graduate clinician will regularly consult with a staffed clinical supervisor(s) and other graduate students about the therapy services provided to you. During a consultation, your graduate clinician will make every effort to avoid revealing your identity. Your graduate clinician’s supervisor and all fellow graduate clinicians are also legally bound to keep the information confidential. If you don’t object, your graduate clinician will not tell you about these consultations unless the clinician feels that it is important to your work together. Your graduate clinician will note all consultations in your Clinical Record (which is called personal health information or “PHI” in the AUPSC Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information). • You should be aware that many graduate clinicians and other mental health professionals practice at AUPSC and that AUPSC employs administrative staff. In most cases, your graduate clinician will need to share protected information, such as your name and the type of services you are receiving with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff 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. • If a client threatens to self harm, your graduate clinician and/or your graduate clinician’s supervisor may be obligated to seek hospitalization for the client, or to contact family members or others who can help provide protection. There are some situations where your graduate clinician and/or your graduate clinician’s supervisor are permitted or required to disclose information without either your consent or authorization: • If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-client privilege law. AUPSC cannot provide any information without your (or your legal representative’s) written authorization or a court order. If you are involved or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order AUPSC to disclose information. • If a government agency is requesting the information for health oversight activities, AUPSC is required to provide it for them. • If a client files a complaint or lawsuit against AUPSC, a graduate clinician, or a supervisor at AUPSC, AUPSC, the graduate clinician, or the supervisor may disclose relevant information regarding that client in order to defend AUPSC, the graduate clinician, or the supervisor. • If a client files a worker’s compensation claim, AUPSC may disclose information relevant to that claim to the client’s employer or the insurer. There are some situations in which AUPSC is legally obligated to take actions, which AUPSC believes are necessary to attempt to protect others from harm, and AUPSC may have to reveal some information about a client’s treatment. • If your graduate clinician or your graduate clinician’s supervisor knows or suspects that a child under the age of 18 has been abused or neglected, the law requires that clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor knows that an elderly or disabled adult has been abused, neglected, exploited, or sexually or emotionally abused, the law requires that the clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor believe that disclosing information about you is necessary to prevent or lessen a serious and imminent threat to the health and safety of an identifiable person(s), your graduate clinician or your graduate clinician’s supervisor may disclose that information, but only to those reasonably able to prevent or lessen the threat. If one of these situations arises, your graduate clinician or your graduate clinician’s supervisor will make every effort to fully discuss it with you before taking any action, and the clinician will try to limit disclosure to what is necessary. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws governing confidentiality can be quite complex. In situations where specific advice is required, formal legal advice may be needed. PROFESSIONAL RECORDS You should be aware that, pursuant to HIPAA, AUPSC keeps Protected Health Information about you in one professional record, which is referred to as your Clinical Record. It includes information about your reasons for seeking therapy, a description of the ways in which your problem impacts your life, your diagnosis, the goals that you and your graduate clinician set for treatment, your progress towards those goals, your medical and social history, your treatment history, any past treatment records that AUPSC receives from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier. If you provide AUPSC with an appropriate written request, you have the right to examine and/or receive a copy of your records, except in unusual circumstances that involve danger to you or others. In those situations, you have a right to have your record sent to another mental health provider. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. For this reason, AUPSC recommends that you initially review them in the presence of your graduate clinician as well as the staffed supervisor or have them forwarded to another mental health professional so you can discuss the contents. You will be charged the same hourly rate you pay for a therapy session for this review meeting. In most situations, AUPSC is allowed to charge a fee of $20 to cover the expense of accessing the file, copying the materials, and forwarding them to the mental health professional of your choice. The exceptions to this policy are contained in the accompanied Notice Form. If XXXXX refuses your request for access to your records, you have a right of review, which can be discussed with you upon request. In addition to keeping records of therapy in your Clinical Record, sessions at AUPSC, whether in person or via telehealth, are recorded for the purposes of supervision and clinical service delivery. Direct observations of in person and telehealth sessions by supervisors may also take place. However, this is not done without first discussing the observation with the client or the client’s caregivers recordings and the information on them will be afforded all of the protection that is given a Clinical Record. RESEARCH Certain forms are routinely completed by all clients at AUPSC and their caregivers. One purpose of these forms is to help graduate clinicians make informed decisions regarding evaluations and treatment. The forms are also used for research purposes. Ongoing research is important so that we can continue to improve the way we provide services at AUPSC. Biographical and psychological data are available to graduate students for research purposes. However, to protect the privacy of our clients, all identifying names, places, and events are removed when information from AUPSC records are used in any research project. CLIENT RIGHTS HIPAA provides you with the following rights with regard to your Clinical Record and disclosures of Protected Health Information: requesting that your graduate clinician amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of Protected Health Information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about AUPSC policies and procedures recorded in your records; and the right to a copy of this Agreement, the accompanied Notice Form, and AUPSC privacy policies and procedures. Your graduate clinician or other AUPSC representative will be happy to discuss any of these rights with you. MINORS & PARENTS Clients under 14 years of age, who are not emancipated, and their caregiver(s), should be aware that the law may allow caregivers to examine their child’s treatment records unless the child’s graduate clinician or the child’s graduate clinician’s supervisor decides that such access is likely to injure the child, or the child’s graduate clinician, the child, and the child’s caregiver(s) agree otherwise. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes AUPSC policy to request an agreement from caregiver(s) that they consent to give up their access to their child’s records. If they agree, during treatment, the graduate clinician will provide them only with general information about the progress of the child’s treatment, and the client’s attendance at scheduled sessions. The graduate clinician will also provide caregivers with a summary of their child’s treatment when it is complete. Any other communication will require the child’s authorization, unless the graduate clinician feels that the child is in danger or is a danger to someone else, in which case, the graduate clinician will notify the caregivers of the clinician’s concern. Before giving caregiver(s) any information, the graduate clinician will discuss the matter with the child, if possible, and do the clinician’s best to handle any objections the child may have. INFORMED CONSENT FOR TELEPSYCHOLOGY This section contains important information focusing on doing psychotherapy using the phone or video conferencing through the Internet at AUPSC. Please read carefully and discuss any questions or concerns you may have with your graduate clinician.

Clinician. You may contact your graduate clinician or their supervisor through email at xxxxxxx@xxxxxx.xxx or by phone at 000-000-0000. Due to your graduate clinician’s work and class schedule, the graduate clinician will often not be immediately available by email or phone. You are encouraged to make every effort to keep your scheduled appointments with your graduate clinician. In the event that you need to reschedule an appointment, contact your graduate clinician via AUPSC phone number or email at least one working day in advance of your scheduled session. Communications with graduate clinicians may change based on University operations. When AUPSC operations are remoteis closed, you may leave a message on the AUPSC answering machine machine, but it may will not be returned immediatelyimmediately (i.e., will be returned when clinic operations resume). Email is checked during business hours Monday through Friday, except during Auburn University holidaysholidays or clinic closures. At other times, you can send an email and your graduate clinician will reach out as soon as possiblepossible when the clinic is open. If you are difficult to reach, please inform your graduate clinician of times when you will be availableavailable and your preferred contact method. AUPSC is not available for emergent services. In case of an emergency that occurs when AUPSC is closed (from 7 pm until 8 am Monday through Thursday and from 5 12 pm Friday until 8 am Monday) please call 9-1-1 or contact the nearest emergency room and ask for the on call psychiatric nurse. The number for the East Alabama Medical Center is (000) 000-0000. Because AUPSC is a university clinic, staffed by graduate student clinicians, there are times when your graduate clinician might not be available for an extended time, such as during a school break. These breaks occur between semesters and typically last for one week, except for the winter holiday, which lasts for two up to four weeks. If you or your graduate clinician determines that you need continuous services that cannot be provided at AUPSC, your graduate clinician will provide you with a referral to an agency or therapist that can provide the services you need. LIMITS ON CONFIDENTIALITY The law protects the privacy of all communications between a client and a psychologist. In most situations, your graduate clinician and/or the clinical supervisor can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAAform. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • Because AUPSC is a training clinic, and your therapist will be a graduate clinician, your graduate clinician will regularly consult with a staffed clinical supervisor(s) and other graduate students about the therapy services provided to you. During a consultation, your graduate clinician will make every effort to avoid revealing your identity. Your graduate clinician’s supervisor and all fellow graduate clinicians are also legally bound to keep the information confidential. If you don’t object, your graduate clinician will not tell you about these consultations unless the clinician feels that it is important to your work together. Your graduate clinician will note all consultations in your Clinical Record (which is called personal health information or “PHI” in the AUPSC Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information)Record. • You should be aware that many graduate clinicians and other mental health professionals practice at AUPSC and that AUPSC employs administrative staff. In most cases, your graduate clinician will need to share protected information, such as your name and the type of services you are receiving with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff 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. • If a client threatens to self self-harm, your graduate clinician and/or your graduate clinician’s supervisor may be obligated to seek hospitalization for the client, or to contact family members or others who can help provide protection. There are some situations where your graduate clinician and/or your graduate clinician’s supervisor are permitted or required to disclose information without either your consent or authorization: • If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-client privilege law. AUPSC cannot provide any information without your (or your legal representative’s) written authorization or a court order. If you are involved or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order AUPSC to disclose information. • If a government agency is requesting the information for health oversight activities, AUPSC is required to provide it for them. • If a client files a complaint or lawsuit against AUPSC, a graduate clinician, or a supervisor at AUPSC, AUPSC, the graduate clinician, or the supervisor may disclose relevant information regarding that client in order to defend AUPSC, the graduate clinician, or the supervisor. • If a client files a worker’s compensation claim, AUPSC may disclose information relevant to that claim to the client’s employer or the insurer. There are some situations in which AUPSC is legally obligated to take actions, which AUPSC believes are necessary to attempt to protect others from harm, and AUPSC may have to reveal some information about a client’s treatment. • If your graduate clinician or your graduate clinician’s supervisor knows or suspects that a child under the age of 18 19 has been abused or neglected, the law requires that clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor knows that an elderly or disabled adult has been abused, neglected, exploited, or sexually or emotionally abused, the law requires that the clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor believe that disclosing information about you is necessary to prevent or lessen a serious and imminent threat to the health and safety of an identifiable person(s), your graduate clinician or your graduate clinician’s supervisor may disclose that information, but only to those reasonably able to prevent or lessen the threat. If one of these situations arises, your graduate clinician or your graduate clinician’s supervisor will make every effort to fully discuss it with you before taking any action, and the clinician will try to limit disclosure to what is necessary. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws governing confidentiality can be quite complex. In situations where specific advice is required, formal legal advice may be needed. PROFESSIONAL RECORDS You should SMOKE FREE CAMPUS AND SUBSTANCE USE POLICY Smoking/vaping is prohibited within all University buildings, facilities, grounds, University-owned vehicles, and property leased to or managed by the University. This policy can be aware thatviewed here: xxxxx://xxxxx.xxxxxx.xxx/admin/universitypolicies/Policies/SmokingPolicy.pdf, pursuant applies to HIPAAall students, AUPSC keeps Protected Health Information about you in one professional recordfaculty, which is referred to as your Clinical Recordstaff, consultants, contractors, and visitors. It includes information about your reasons for seeking therapy, a description of Clients may not be under the ways in which your problem impacts your life, your diagnosis, the goals that you and your graduate clinician set for treatment, your progress towards those goals, your medical and social history, your treatment history, any past treatment records that AUPSC receives from other providers, reports influence of any professional consultationsnon-prescribed substance (e.g., your billing recordsalcohol, and any reports that have been sent to anyone, including reports to your insurance carrier. If you provide AUPSC with an appropriate written request, you have the right to examine and/or receive a copy of your records, except in unusual circumstances that involve danger to you or others. In those situations, you have a right to have your record sent to another mental health provider. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. For this reason, AUPSC recommends that you initially review them in the presence of your graduate clinician as well as the staffed supervisor or have them forwarded to another mental health professional so you can discuss the contents. You will be charged the same hourly rate you pay for a therapy session for this review meeting. In most situations, AUPSC is allowed to charge a fee of $20 to cover the expense of accessing the file, copying the materials, and forwarding them to the mental health professional of your choice. The exceptions to this policy are contained in the accompanied Notice Form. If XXXXX refuses your request for access to your records, you have a right of review, which can be discussed with you upon request. In addition to keeping records of therapy in your Clinical Record, marijuana) during their sessions at AUPSC. Should it be determined that a client is under the influence of drugs or alcohol, whether in person or via telehealth, are recorded for the purposes of supervision session will be stopped immediately and clinical service deliverysteps to ensure the client's safe transport home will be initiated. Direct observations of in person Should a client attempt to leave and telehealth sessions by supervisors may also take place. Howeverdrive a vehicle under the influence, this is not done without first discussing the observation with the client or may indicate additional steps to ensure the client’s caregivers recordings 's and the information on them will be afforded all of the protection that is given a Clinical Record. RESEARCH Certain forms are routinely completed by all clients at AUPSC and their caregivers. One purpose of these forms is to help graduate clinicians make informed decisions regarding evaluations and treatment. The forms are also used for research purposes. Ongoing research is important so that we can continue to improve the way we provide services at AUPSC. Biographical and psychological data are available to graduate students for research purposes. However, to protect the privacy of our clients, all identifying names, places, and events are removed when information from AUPSC records are used in any research project. CLIENT RIGHTS HIPAA provides you with the following rights with regard to your Clinical Record and disclosures of Protected Health Information: requesting that your graduate clinician amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of Protected Health Information that you have neither consented to nor authorized; determining the location to ' safety which protected information disclosures are sent; having any complaints you make about AUPSC policies and procedures recorded in your records; and the right to a copy of this Agreement, the accompanied Notice Form, and AUPSC privacy policies and procedures. Your graduate clinician or other AUPSC representative will be happy to discuss any of these rights with you. MINORS & PARENTS Clients under 14 years of age, who are not emancipated, and their caregiver(s), should be aware that the law may allow caregivers to examine their child’s treatment records unless the child’s graduate clinician or the child’s graduate clinician’s supervisor decides that such access is likely to injure the child, or the child’s graduate clinician, the child, and the child’s caregiver(s) agree otherwise. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes AUPSC policy to request an agreement from caregiver(s) that they consent to give up their access to their child’s records. If they agree, during treatment, the graduate clinician will provide them only with general information about the progress of the child’s treatment, and the client’s attendance at scheduled sessions. The graduate clinician will also provide caregivers with a summary of their child’s treatment when it is complete. Any other communication will require the child’s authorization, unless the graduate clinician feels that the child is in danger or is a danger to someone else, in which case, the graduate clinician will notify the caregivers of the clinician’s concern. Before giving caregiver(s) any information, the graduate clinician will discuss the matter with the child, if possible, and do the clinician’s best to handle any objections the child may have. INFORMED CONSENT FOR TELEPSYCHOLOGY This section contains important information focusing on doing psychotherapy using the phone or video conferencing through the Internet at AUPSC. Please read carefully and discuss any questions or concerns you may have with your graduate cliniciancompromise confidentiality.

Clinician. You may contact your graduate clinician or their supervisor through email at xxxxxxx@xxxxxx.xxx or by phone at 000-000-0000. Due to your graduate clinician’s work and class schedule, the graduate clinician will often not be immediately available by email or phone. You are encouraged to make every effort to keep your scheduled appointments with your graduate clinician. In the event that you need to reschedule an appointment, contact your graduate clinician via AUPSC phone number or email at least one working day in advance of your scheduled session. Communications with graduate clinicians may change based on University operations. When AUPSC operations are remoteis closed, you may leave a message on the AUPSC answering machine machine, but it may not be returned immediately. Email is checked during business hours Monday through Friday, except during Auburn University holidaysholidays or clinic closures. At other times, you can send an email and your graduate clinician will reach out as soon as possible. If you are difficult to reach, please inform your graduate clinician of times when you will be available. AUPSC is not available for emergent services. In case of an emergency that occurs when AUPSC is closed (from 7 pm until 8 am Monday through Thursday and from 5 12 pm Friday until 8 am Monday) please call the nearest emergency room and ask for the on call psychiatric nurse. The number for the East Alabama Medical Center is (000) 000-0000. Because AUPSC is a university clinic, staffed by graduate student clinicians, there are times when your graduate clinician might not be available for an extended time, such as during a school break. These breaks occur between semesters and typically last for one week, except for the winter holiday, which lasts for two up to four weeks. If you or your graduate clinician determines that you need continuous services that cannot be provided at AUPSC, your graduate clinician will provide you with a referral to an agency or therapist that can provide the services you need. LIMITS ON CONFIDENTIALITY The law protects the privacy of all communications between a client and a psychologist. In most situations, your graduate clinician and/or the clinical supervisor can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • Because AUPSC is a training clinic, and your therapist will be a graduate clinician, your graduate clinician will regularly consult with a staffed clinical supervisor(s) and other graduate students about the therapy services provided to you. During a consultation, your graduate clinician will make every effort to avoid revealing your identity. Your graduate clinician’s supervisor and all fellow graduate clinicians are also legally bound to keep the information confidential. If you don’t object, your graduate clinician will not tell you about these consultations unless the clinician feels that it is important to your work together. Your graduate clinician will note all consultations in your Clinical Record (which is called personal health information or “PHI” in the AUPSC Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information). • You should be aware that many graduate clinicians and other mental health professionals practice at AUPSC and that AUPSC employs administrative staff. In most cases, your graduate clinician will need to share protected information, such as your name and the type of services you are receiving with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff 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. • If a client threatens to self harm, your graduate clinician and/or your graduate clinician’s supervisor may be obligated to seek hospitalization for the client, or to contact family members or others who can help provide protection. There are some situations where your graduate clinician and/or your graduate clinician’s supervisor are permitted or required to disclose information without either your consent or authorization: • If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-client privilege law. AUPSC cannot provide any information without your (or your legal representative’s) written authorization or a court order. If you are involved or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order AUPSC to disclose information. • If a government agency is requesting the information for health oversight activities, AUPSC is required to provide it for them. • If a client files a complaint or lawsuit against AUPSC, a graduate clinician, or a supervisor at AUPSC, AUPSC, the graduate clinician, or the supervisor may disclose relevant information regarding that client in order to defend AUPSC, the graduate clinician, or the supervisor. • If a client files a worker’s compensation claim, AUPSC may disclose information relevant to that claim to the client’s employer or the insurer. There are some situations in which AUPSC is legally obligated to take actions, which AUPSC believes are necessary to attempt to protect others from harm, and AUPSC may have to reveal some information about a client’s treatment. • If your graduate clinician or your graduate clinician’s supervisor knows or suspects that a child under the age of 18 19 has been abused or neglected, the law requires that clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor knows that an elderly or disabled adult has been abused, neglected, exploited, or sexually or emotionally abused, the law requires that the clinician file a report with the appropriate governmental agency, usually the Alabama Department of Human Resources. Once such a report is filed, AUPSC may be required to provide additional information. • If your graduate clinician or your graduate clinician’s supervisor believe that disclosing information about you is necessary to prevent or lessen a serious and imminent threat to the health and safety of an identifiable person(s), your graduate clinician or your graduate clinician’s supervisor may disclose that information, but only to those reasonably able to prevent or lessen the threat. If one of these situations arises, your graduate clinician or your graduate clinician’s supervisor will make every effort to fully discuss it with you before taking any action, and the clinician will try to limit disclosure to what is necessary. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws governing confidentiality can be quite complex. In situations where specific advice is required, formal legal advice may be needed. PROFESSIONAL RECORDS You should be aware that, pursuant to HIPAA, AUPSC keeps Protected Health Information about you in one professional record, which is referred to as your Clinical Record. It includes information about your reasons for seeking therapy, a description of the ways in which your problem impacts your life, your diagnosis, the goals that you and your graduate clinician set for treatment, your progress towards those goals, your medical and social history, your treatment history, any past treatment records that AUPSC receives from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier. If you provide AUPSC with an appropriate written request, you have the right to examine and/or receive a copy of your records, except in unusual circumstances that involve danger to you or others. In those situations, you have a right to have your record sent to another mental health provider. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. For this reason, AUPSC XXXXX recommends that you initially review them in the presence of your graduate clinician as well as the staffed supervisor or have them forwarded to another mental health professional so you can discuss the contents. You will be charged the same hourly rate you pay for a therapy session for this review meeting. In most situations, AUPSC is allowed to charge a fee of $20 to cover the expense of accessing the file, copying the materials, and forwarding them to the mental health professional of your choice. The exceptions to this policy are contained in the accompanied Notice Form. If XXXXX refuses your request for access to your records, you have a right of review, which can be discussed with you upon request. In addition to keeping records of therapy in your Clinical Record, sessions at AUPSC, whether in person or via telehealth, are recorded for the purposes of supervision and clinical service delivery. Direct observations of in person and telehealth sessions by supervisors may also take place. However, this is not done without first discussing the observation with the client or the client’s caregivers recordings and the information on them will be afforded all of the protection that is given a Clinical Record. RESEARCH Certain forms are routinely completed by all clients at AUPSC and their caregivers. One purpose of these forms is to help graduate clinicians make informed decisions regarding evaluations and treatment. The forms are also used for research purposes. Ongoing research is important so that we can continue to improve the way we provide services at AUPSC. Biographical and psychological data are available to graduate students for research purposes. However, to protect the privacy of our clients, all identifying names, places, and events are removed when information from AUPSC records are used in any research project. CLIENT RIGHTS HIPAA provides you with the following rights with regard to your Clinical Record and disclosures of Protected Health Information: requesting that your graduate clinician amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of Protected Health Information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about AUPSC policies and procedures recorded in your records; and the right to a copy of this Agreement, the accompanied Notice Form, and AUPSC privacy policies and procedures. Your graduate clinician or other AUPSC representative will be happy to discuss any of these rights with you. MINORS & PARENTS Clients under 14 years of age, who are not emancipated, and their caregiver(s), should be aware that the law may allow caregivers to examine their child’s treatment records unless the child’s graduate clinician or the child’s graduate clinician’s supervisor decides that such access is likely to injure the child, or the child’s graduate clinician, the child, and the child’s caregiver(s) agree otherwise. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is sometimes AUPSC policy to request an agreement from caregiver(s) that they consent to give up their access to their child’s records. If they agree, during treatment, the graduate clinician will provide them only with general information about the progress of the child’s treatment, and the client’s attendance at scheduled sessions. The graduate clinician will also provide caregivers with a summary of their child’s treatment when it is complete. Any other communication will require the child’s authorization, unless the graduate clinician feels that the child is in danger or is a danger to someone else, in which case, the graduate clinician will notify the caregivers of the clinician’s concern. Before giving caregiver(s) any information, the graduate clinician will discuss the matter with the child, if possible, and do the clinician’s best to handle any objections the child may have. INFORMED CONSENT FOR TELEPSYCHOLOGY This section contains important information focusing on doing psychotherapy using the phone or video conferencing through the Internet internet at AUPSC. Please read carefully and discuss any questions or concerns you may have with your graduate clinician. Telepsychology services can only be delivered to clients within the state of Alabama.