Uses and Disclosures with Neither Consent nor Authorization. I may use or disclose PHI without your consent or authorization in the following circumstances: • Child Abuse – If I have reasonable cause to believe that a child has been abused, I must report that belief to the appropriate authority. • Adult and Domestic Abuse – If I have reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, I must report that belief to the appropriate authority.
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Samples: www.restoredheartscounseling.com, www.restoredheartscounseling.com
Uses and Disclosures with Neither Consent nor Authorization. Without your consent or authorization, I may use or disclose PHI without your consent or authorization in the following circumstances: • Child Abuse – If I have reasonable cause to believe that a child has been abused, I must report that belief to the appropriate authority. • Adult and Domestic Abuse – If I have reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, I must report that belief to the appropriate authority.
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Samples: Please Complete And
Uses and Disclosures with Neither Consent nor Authorization. I may use or disclose PHI without your consent or authorization in the following circumstances: • Child Abuse – If I have reasonable cause to believe that a child has been abused, I must report that belief to the appropriate authority. • Adult and Domestic Abuse – If I have reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, I must report that belief to the appropriate authority.
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Samples: Psychotherapy Agreement