CLIENT RIGHTS & RESPONSIBILITIES
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CLIENT RIGHTS
AS A CLIENT OF THIS PROGRAM YOU HAVE CERTAIN RIGHTS WHICH APPLY TO
YOUR RELATIONSHIP TO THIS AGENCY.
ALL CLIENTS HAVE THE:
I. RIGHT TO NOTIFICATION
YOU MUST BE GIVEN ACCESS TO A COPY OF THE INFORMED CONSENT/SERVICES
AGREEMENT WHEN YOU REGISTER FOR COUNSELING. THIS AGREEMENT/CONSENT
FORM MUST INCLUDE A CLEAR STATEMENT OF: 1) SERVICES WHICH WILL BE
PROVIDED; 2) ALL PARTIES (COUNSELORS, CLIENTS, AGENCIES) INCLUDED
IN THE AGREEMENT; 3) THE CREDENTIALS, CERTIFICATIONS, AND
LICENSURE STATUS OF THE ASSIGNED COUNSELOR; 4) POLICIES GOVERNING
FEES AND INSURANCE; 5) POLICIES GOVERNING CANCELLATION OF
APPOINTMENTS; 6) POLICIES GOVERNING CONFIDENTIALITY AND LIMITS OF
CONFIDENTIALITY; 7) POLICIES GOVERNING ARBITRATION OF DISPUTES;
8) POLICIES GOVERNING REFERRAL AND TERMINATION; AND 9) A
GENERAL WORKING AGREEMENT GOVERNING THE COUNSELING PROCESS.
II. RIGHT TO TREATMENT
THIS PROGRAM DOES NOT DENY SERVICES TO YOU SOLELY ON THE BASIS OF
RACE, NATIONAL ORIGIN,SEX, AGE, RELIGION, OR HANDICAP. IN THE
EVENT A COUNSELOR OF YOUR PREFERENCE IS NOT AVAILABLE WHEN YOU
APPLY FOR SERVICES, YOU SHALL BE GIVEN THE OPTION OF BEING PLACED
ON A WAITING LIST, OR REFERRED TO ANOTHER AGENCY. SINCE THIS IS
A PRIVATE CHRISTIAN AGENCY, IT DOES RESERVE THE RIGHT TO REFUSE
SERVICES TO THOSE WHO OPENLY DISAGREE WITH THE STATED RELIGIOUS
VIEWS OF THE AGENCY OR THOSE WHO WILL NOT, OR CANNOT PAY LEGITIMATE
FEES FOR SERVICES. IF, IN THE OPINION OF THE AGENCY, YOU WOULD BE
BETTER AND MORE EFFECTIVELY SERVED BY ANOTHER AGENCY, YOU HAVE THE
RIGHT TO REQUEST A REFERRAL.
IF ACCEPTED FOR SERVICES, AN INDIVIDUAL TREATMENT PLAN MUST BE
DEVELOPED FOR YOU, AND YOU HAVE THE RIGHT TO PARTICIPATE WITH THE
STAFF IN MAKING DECISIONS ABOUT YOUR TREATMENT. YOUR ABILITY TO
UNDERSTAND AND MAKE DECISIONS ABOUT TREATMENT WILL BE REVIEWED. IF
A CLIENT SEEMS UNABLE TO UNDERSTAND AND MAKE DECISIONS ABOUT
TREATMENT, AN "AUTHORIZED REPRESENTATIVE" MAY BE APPOINTED (IN
COOPERATION WITH THE CLIENT'S FAMILY OR LEGAL GUARDIANS) TO MAKE
DECISIONS FOR THE CLIENT. IF THERE IS DISAGREEMENT WITH THIS, THE
CLIENT (if able) OR GUARDIAN WILL HAVE OPPORTUNITY TO OBJECT.
III. RIGHT TO CONFIDENTIALITY
YOUR RECORDS WILL BE RELEASED ONLY WITH YOUR CONSENT OR THE CONSENT
OFYOUR AUTHORIZED REPRESENTATIVE, OR BY COURT ORDER, EXCEPT IN
EMERGENCIES, OR AS OTHERWISE PERMITTED BY LAW. YOU HAVE THE RIGHT
TO INSPECT AND COPY YOUR RECORDS AT YOUR OWN EXPENSE, EXCEPT WHERE
IT MIGHT BE HARMFUL TO YOU. IF, IN THE OPINION OF THE STAFF OF
THIS AGENCY, VIEWING YOUR RECORDS POSES A POSSIBLE HARM TO YOU, A
LAWYER, DOCTOR, OR PSYCHOLOGIST OF YOUR CHOICE CAN VIEW YOUR
RECORDS IN THE OFFICES OF THIS AGENCY WITH AN AGENCY REPRESENTATIVE
PRESENT. IF YOU FEEL THERE ARE MISTAKES IN YOUR RECORD, YOU CAN
ASK TO HAVE THEM CORRECTED. IF THE AGENCY CHOOSES NOT TO CORRECT
WHAT YOU THINK IS AN ERROR, YOU CAN PLACE YOUR STATEMENT ABOUT THE
ERROR IN YOUR RECORD.
IV. RIGHT TO CONSENT
A TREATMENT OR SERVICE WHICH PRESENTS A "SIGNIFICANT RISK" - THAT
IS ONE THAT MIGHT CAUSE SOME INJURY OR HAVE SERIOUS SIDE EFFECT -
MAY NOT BE ADMINISTERED UNLESS YOU OR YOUR AUTHORIZED REPRESENTATIVE
FIRST GIVES INFORMED CONSENT.
V. RIGHT TO DIGNITY
YOU HAVE THE RIGHT TO BE ADDRESSED BY YOUR PREFERRED LEGAL NAME, TO
BE PROTECTED FROM ABUSE, TO BE TREATED WITH RESPECT AND COURTESY,
AND TO BE CONSULTED IN MATTERS RELATED TO YOUR THERAPY PROGRAM.
VI. RIGHT TO LEAST INTRUSIVE THERAPY
YOU HAVE THE RIGHT TO PERSONAL AUTONOMY, TO UNDERSTAND THE NATURE
AND PURPOSE OF ANY THERAPEUTIC TECHNIQUE, TO REFUSE TO COOPERATE
WITH ANY ASSIGNMENT WITH WHICH YOU DISAGREE, TO REFUSE TO DISCLOSE
ANY INFORMATION YOU DO NOT WISH TO DISCLOSE.
VII: RIGHT TO PRIVACY AND SAFETY
YOU HAVE THE RIGHT TO MAINTAIN THE PRIVACY OF YOUR PHYSICAL PERSON.
UNDER NO CIRCUMSTANCES DOES A THERAPIST HAVE THE RIGHT TO TOUCH A
CLIENT IN ANY MANNER THAT MIGHT BE CONSIDERED AS SEXUAL TOUCHING.
SEX IS NEVER APPROPRIATE IN THERAPY BETWEEN CLIENT AND THERAPIST,
EVEN WITH CLIENT CONSENT.
YOU HAVE THE RIGHT TO SAFETY FROM PHYSICAL AND VERBAL ABUSE.
THERAPIST MAY NOT STRIKE, PUSH, OR THREATEN A CLIENT WITH PHYSICAL
HARM. IF IN THE EVENT OF CLIENT AGGRESSION, THERAPISTS MAY DEFEND
THEMSELVES FROM ASSAULT AND BRING CHARGES AGAINST A CLIENT.
YOU HAVE THE RIGHT TO PRIVACY OUTSIDE THE COUNSELING AGENCY.
THERAPIST ARE FORBIDDEN (IN SOME CASES BY STATE LAW) FROM
CONTACTING A CLIENT OUTSIDE THE COUNSELING AGENCY EXCEPT IN CASES
OF EMERGENCY, INVIVO THERAPY APPROVED BY AN AGENCY REPRESENTATIVE,
OR FOR AGENCY APPROVED REQUIREMENTS. CLIENTS HAVE THE RIGHT TO
REQUEST NOT TO BE CONTACTED EXCEPT IN CASES OF EMERGENCY OR
RESCHEDULING.
VIII. RIGHT TO MEDIATION OF ALL DISPUTES
YOU HAVE THE RIGHT TO THIRD-PARTY MEDIATION OF ALL DISPUTES
REGARDING YOUR THERAPY PROGRAM AND DISAGREEMENTS BETWEEN YOU AND
YOUR COUNSELOR. A PROCEDURE SHOULD BE CLEARLY STATED ON THE
SERVICES AGREEMENT/CONSENT FORM ABOUT MEDIATION. IF YOU BELIEVE
ANY RIGHTS STATED HERE HAVE BEEN VIOLATED, YOU MAY ASK TO FILE A
WRITTEN COMPLAINT. THE DESIGNATED MEDIATOR FOR THIS AGENCY MAY ASK
TO MEET WITH YOU TO DISCUSS YOUR GRIEVANCE. HE MAY THEN SUGGEST A
MEETING AT WHICH YOUR COUNSELOR IS PRESENT. IF YOU ARE STILL
DISSATISFIED AFTER THESE MEETINGS, THE MEDIATOR WILL ADVISE YOU OF
YOUR RIGHTS AND OPTIONS.
CLIENT RESPONSIBILITIES
AS A CLIENT YOU HAVE RESPONSIBILITIES RELATED TO YOUR THERAPEUTIC
PROGRAM. FULFILLING THESE RESPONSIBILITIES WILL ENABLE YOU TO
RECEIVE THE MOST EFFECTIVE SERVICES.
THE CLIENT IS RESPONSIBLE TO:
I. PROVIDE ESSENTIAL INFORMATION
IT IS YOUR RESPONSIBILITY TO PROVIDE THE AGENCY AND YOUR COUNSELOR
WITH ALL POSSIBLE INFORMATION ABOUT YOUR PROBLEMS, SOCIAL AND
ECONOMIC HISTORY, PAST ILLNESS AND HOSPITALIZATIONS, MEDICATIONS
YOU HAVE OR ARE PRESENTLY TAKING, MEDICAL AND PHYSICAL HISTORY,
DRUGS OR ALCOHOL USE, RELATIONSHIPS AND FAMILY HISTORY, OR OTHER
MATTERS RELATING TO YOUR MENTAL OR PHYSICAL HEALTH. YOU HAVE
RESPONSIBILITY TO REPORT CHANGES IN YOUR MENTAL OR PHYSICAL HEALTH,
LIVING CONDITIONS, FAMILY, JOB, OR OTHER CONDITIONS THAT MAY IMPACT
YOUR MENTAL OR PHYSICAL WELLBEING. YOU ARE RESPONSIBLE FOR
INFORMING AGENCY STAFF ABOUT ANY DIFFICULTY IN UNDERSTANDING
INFORMATION YOU ARE GIVEN REGARDING WHAT IS EXPECTED OF YOU DURING
YOUR THERAPY PROGRAM.
II. COMPLY WITH AGREED TREATMENT PLANS AND SERVICES
YOU ARE RESPONSIBLE FOR ACTIVELY PARTICIPATING IN THE PLANNING AND
PROGRESS OF YOUR TREATMENT PROGRAM. YOU ARE RESPONSIBLE FOR
COMMUNICATING ANY DIFFICULTIES OR DISAGREEMENTS TO YOUR COUNSELOR.
IT IS YOUR RESPONSIBILITY TO KEEP YOUR SCHEDULED APPOINTMENTS OR
NOTIFY THIS AGENCY TWENTY-FOUR HOURS IN ADVANCE IF YOU CANNOT.
III. REFUSE TREATMENT THAT YOU DO NOT WANT TO PARTICIPATE IN AND
ACCEPT THE CONSEQUENCES OF THAT REFUSAL
YOU ARE RESPONSIBLE FOR THE CONDUCT OF YOUR THERAPY PROGRAM. YOU
MAY ELECT TO REFUSE CERTAIN TREATMENTS OR ASSIGNMENTS AND DISCUSS
THE REASONS FOR YOUR REFUSAL WITH YOUR COUNSELOR. IF YOU CANNOT
AGREE TO A PLAN FOR PROGRESSING FROM THAT POINT, YOU MAY REQUEST
MEDIATION TO REVIEW YOUR OPTIONS FOR REFERRAL OR DISCONTINUANCE OF
COUNSELING.
IV. PAY AGREED FEES
YOU ARE RESPONSIBLE TO PAY ALL FEES FOR SERVICES AS PROMPTLY AS
POSSIBLE. TESTS AND OTHER SERVICES NOT DEFINED IN YOUR ORIGINAL
AGREEMENT MUST BE AGREED TO IN WRITING BEFORE THEY ARE APPLIED
OR BILLED.
V. FOLLOW PROGRAM RULES AND REGULATIONS
YOU ARE RESPONSIBLE FOR FOLLOWING ALL PROGRAM RULES AND REGULATIONS
WHICH APPLY TO CLIENT CARE AND BEHAVIOR. IF YOU DO NOT UNDERSTAND
A RULE OR REGULATION YOU ARE RESPONSIBLE FOR SEEKING CLARIFICATION.
VI. RESPECT AND CONSIDER OTHER CLIENTS AND AGENCY STAFF
YOU ARE RESPONSIBLE TO BE CONSIDERATE OF THE RIGHTS OF OTHER
CLIENTS AND AGENCY STAFF. YOU ARE RESPONSIBLE FOR RESPECTING THE
PROPERTY AND PRIVACY OF OTHER CLIENTS AND AGENCY STAFF.
VII. RESPECT APPROPRIATE BOUNDARIES OF THE COUNSELING RELATIONSHIP
YOU ARE RESPONSIBLE FOR RESPECTING THE LIMITS OF THE RELATIONSHIP
YOU ESTABLISH WITH YOUR COUNSELOR. CONTACT WITH YOUR COUNSELOR
SHOULD BE LIMITED TO THE APPOINTMENTS SCHEDULED AT THIS AGENCY.
YOU SHOULD NOT TELEPHONE, FAX, OR E-MAIL YOUR COUNSELOR'S HOME OR
OTHER PLACES OF WORK, OR INVADE YOUR COUNSELOR'S PRIVACY IN PUBLIC
OR USE ANY MEANS TO INFRINGE UPON THE PERSONAL LIFE OF YOUR
COUNSELOR. YOU SHOULD NOT SEEK ADVICE OR DISCUSSION OF ANY MATTERS
BETTER LEFT TO THE THERAPY SESSION.
IN CASE OF EMERGENCIES, YOU MAY NOT TELEPHONE YOUR COUNSELOR UNLESS
YOU ARE GIVEN WRITTEN PERMISSION, WITH AGENCY APPROVAL TO DO SO.
IF, IN YOUR OPINION, YOU MAY REQUIRE EMERGENCY SERVICES DURING THE
COURSE OF THERAPY, YOU SHOULD REQUEST A LIST OF TELEPHONE NUMBERS
AVAILABLE FOR SUCH PURPOSES.
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