EAP STATEMENT OF UNDERSTANDING AND AGREEMENT ON CONFIDENTIALITY
The services provided by your EAP may include: consultation, coaching, short-term counseling, information and/or referral services. All of these services are provided at no cost to you. If your situation requires further or more
specialized services, a referral will be made to other resources within our agency or the community. It is important to note that any costs associated with additional services will be your responsibility. Your health insurance plan may cover some of the costs and the EAP staff will assist to the fullest extent possible.
YOUR RIGHTS AS A CLIENT OF OUR PROGRAM
As a client of Child & Family Services’ Employee Assistance Program (C&FS EAP), you are entitled and welcome to:
- Inquire about the professional qualifications of C&FS EAP staff who will be providing services for you;
- Inquire about and comment on agency/program policies and procedures;
- Make suggestions as to how our services and/or procedures may be improved;
- All personal information provided will be managed in accordance with HIPAA regulations, a copy of these
regulations and agency/program’s Confidentiality Policy will be made available upon request
Resolution of Concerns/Complaints
C&FS EAP is dedicated to providing the highest quality services. If we do not meet the standard of care that was expected, we encourage you to reach out to any C&FS EAP staff member. The concern/complaint will be explored to
the fullest extent possible. We will provide the results of the exploration process to the extent possible, while adhering to HIPAA requirements.
In an effort to respect availability of appointments, we kindly request that you provide a minimum of 24 hours’ notice if you are unable to attend your scheduled session. This notice will allow for someone else to take advantage of this appointment slot. If cancellation notice is not provided within 24 hours, the scheduled session may be counted as one of your allowed sessions through EAP.
In the Event of Building Evacuation:
If for any reason there is an evacuation, the C&FS EAP staff will provide direction to safely exit the building. You may resume meeting at conclusion of evacuation if times allows, or reschedule as needed.
Notice of Privacy:
The Health Insurance and Probability Act of 1996 (‘HIPAA’) requires that we provide you with a copy of the Agency’s Privacy Practices upon request, and that we make a good faith attempt to obtain your acknowledgment of the receipt.
Consent to Telehealth and In-person services:
Telehealth and in-person services allow the EAP counselor to consult, coach and educate in-person and using interactive audio, video or data communication. I have the right to confidentiality. Any information disclosed by me
during the course of service is confidential under the guidelines of HIPAA excluding information given around state requirements for mandated reporting, duty to warn and where there is a real and immediate threat of suicide.