CLIENT RIGHTS AND RESPONSIBILITIES

Confidentiality

• Information regarding a client’s treatment will not be disclosed to anyone outside of CFA without the appropriate authorization, except as permitted or required by law.
• To support coordinated care, CFA staff may share information between CFA programs as permitted by law and CFA policy.
• When more than one adult name is in a record, authorization from all applicable adults may be required before information is shared.
• CFA’s role is to support the client’s mental and physical health and well-being. CFA does not participate in custody disputes or provide written recommendations relating to custody.
• CFA continually evaluates its programs to improve services for children and families. De-identified information may be used for internal quality improvement, reporting, statistical purposes, and funding requirements. Any use of identifiable Protected Health Information (PHI) for external research will occur only with appropriate written authorization or approval by an Institutional Review Board (IRB) or Privacy Board, as required by law.

Client Rights
Clients have the right to:

• Receive equal treatment without regard to race, color, spiritual beliefs, sex, gender identity, sexual orientation, and/or national origin.
• Receive services that take into consideration the client’s culture and spoken language.
• Participate actively in treatment planning, and ongoing decisions regarding services.
• Review the client’s record, subject to applicable confidentiality laws and Agency policy.
  Record reviews are conducted in the presence of the treating provider and/or supervisor. CFA will determine whether review or release of information may be harmful to a minor client, as permitted by law.
  
• Subpoena CFA treating clinician or provider for written or verbal testimony. Fees may apply.
• Request a change in staff assignment.
• Refuse services at any time. The clients should discuss with their assigned clinician.
• Seek another opinion from an individual or organization outside of CFA regarding diagnosis, medications, or treatment planning.
• Decline any audio/audiovisual taping.
• Receive information regarding risks, benefits, and alternatives associated with the proposed treatment or service plan.
• Request information regarding the professional education and experience of the treating clinician.
• Request a Good Faith Estimate.
• Express concerns regarding services and request changes when appropriate.
• Express concerns about the CFA policies and procedures.
  The agency’s Grievance Procedure is available for review and reference on our website at Grievance Procedure
  

Client Responsibilities
Clients and parents/legal guardians are responsible for:

Maintaining a Safe and Respectful Treatment Environment

• Treating CFA staff, family members, and other clients with respect.
• Maintaining a safe and appropriate treatment environment.
• Refraining from rude or obscene language, appearing under the influence of alcohol or other substances, and making verbal or physical threats while receiving services.
• Understanding that threats and actions involving harm to oneself or others are not protected by confidentiality and may be reported to the appropriate authorities.
• Ensuring that weapons are not brought onto CFA premises. When services are provided in the home, weapons must be disclosed, secured, and safely stored.
• Understanding that behaviors that compromise the safety of clients, families, or CFA staff may result in changes to services, including discharge from CFA services.
• Not recording, photographing, or otherwise capturing, or sharing or distributing, video, audio, or photographs of CFA services, staff, clients, or family members.

Participating in Treatment

• Participating actively in treatment and attending scheduled appointments as recommended by the treatment team.
• Following program expectations and treatment recommendations discussed during intake and throughout the course of services.
• Providing accurate and complete information regarding medical history, medications, symptoms, and other information necessary for treatment.
• Notifying CFA promptly of changes to contact information, insurance coverage, or legal custody that may affect treatment, communication, or service coordination.
• Understanding that failure to participate in services, maintain attendance, or meet program expectations may result in discharge from CFA services.

Managing Financial Responsibilities

• Providing and maintaining accurate and current financial, insurance, and contact information necessary to determine eligibility, billing, and payment for services.
• Reviewing and signing CFA’s Financial Responsibility Agreement.

Telehealth Agreement
Telehealth allows CFA providers to diagnose/evaluate, consult, treat, educate, and manage care using interactive audio, video or data communication.

• I agree not to record and/or distribute my telehealth therapy sessions.