Common use of Records and Confidentiality Clause in Contracts

Records and Confidentiality. Your mental health record is accessible to you upon request. In some instances, one parent or one individual in couple's counseling may request a copy of the family/couple's records. A fee of $45.00 will be charged for the first 25 pages of the record and additional pages will be at a rate of $1.00 per page. When one member of the couple or one of the parents requests a copy of the record, the other parent/individual in couple's counseling will also be offered a copy of the record at an additional cost of $45.00 for the first 25 pages and $1.00 for each additional page. This does not include postage and handling. You will be given a receipt after each session or payment for your records. When a request is made directly from a government agency or official, there is NO charge. Initials /

Records and Confidentiality. Your mental health record is accessible to you upon request. In some instances, one parent or one individual in couple's counseling may request a copy of the family/couple's records. A fee of $45.00 will be charged for the first 25 pages of the record and additional pages will be at a rate of $1.00 per page. When one member of the couple or one of the parents requests or guardians request a copy of the record, the other parent/individual in couple's counseling will also be offered a copy of the record at an additional the same cost of $45.00 for the first 25 pages and $1.00 for each additional page. This does not include postage and handling. You will be given a receipt upon request after each session or payment for your records. When a request is made directly from a government agency or officialofficial for a record, there is NO charge. Initials /

Records and Confidentiality. Your mental health record is accessible to you upon request. In some instances, one parent or one individual in couple's counseling couple'scounseling may request a copy of the familythefamily/couple's records. A fee of $45.00 will be charged for the first 25 pages of the record and additional pages will be at a rate of $1.00 per page. When one member of the couple or one of the parents requests a copy of the record, the other parent/individual in couple's counseling will couple'scounselingwill also be offered a copy of the record at an additional cost of $45.00 for the first 25 pages and $1.00 for each additional page. This does not include postage and handling. You will be given a receipt after each session or payment for your records. When a request is made directly from a government agency or official, there is NO charge. Initials /Initials_____/_____