Alert: In response to COVID-19, insurance is paying for telehealth/online counseling. Click here to schedule.

Dear Robert,

It was good talking with you today!

Robert, you present a good question about whether the HIPAA watchdog organizations have sanctioned or approved documents—such as informed consent documents–that meet HIPAA requirements.

I have looked for such materials in the past, and have been informed during my searches that there are no such officially approved documents. HIPAA regulations provide general guidelines on what you need to do to protect client information (and provide patients access to their records). However, there is less detailed instruction on how to do this (some companies provide HIPAA training for administrators, and you may want to look into an official training program at some point).

Robert, while I don’t have a ‘sanctioned’ document, I am attaching here excerpts from the informed consent form that my practice in Cambridge, MA has been using for the last 4 years or so. Our informed consent document attends to issues of HIPAA throughout, especially in the section “Confidentiality / Personal Health Information.” Please feel free to use or modify this to your satisfaction. Here is the excerpt:

Confidentiality / Personal Health Information

All communications and records with your counselor are held in strict confidence. Information may be released, in accordance with state law, when:

1) the client signs a written release indicating consent to release

2) the client expresses serious intent to harm self or someone else

3) there is reasonable suspicion of abuse against a minor, elderly person, or dependent adult

4) to acquire payment for services or for billing purposes, or

5) a subpoena or court order is received directing the disclosure of information. To protect your privacy to the greatest extent of the law, it is our policy to assert either:

(a) privileged communication in the event of #5 or
(b) the right to consult with clients, if at all possible, before mandated disclosure in the event of #2 or #3.

Robert, in addition I am attaching a section from our PHI Release Form that follows and addresses HIPAA regulations. Again, here is an excerpt:

“I understand that if I have any questions about my clinical records, or the content within, I can contact Thrive Counseling and someone will meet with me to discuss my records. I understand that my treatment records are protected under the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), 45 CFR, Parts 160 & 164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time and that that any notice to revoke consent must be in writing.”

I hope these materials are of aid to you, and please feel free to contact me anytime with future questions at 1-855-4-THRIVE.


Dr. Anthony Centore

Anthony Centore

Anthony Centore

Anthony Centore Ph.D. is Founder and CEO at Thriveworks--a counseling practice, focused on premium client care, with 80+ locations across the USA. He is Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and Author of How to Thrive in Counseling Private Practice. Anthony is a multistate Licensed Professional Counselor and has been quoted in national media sources including The Boston Globe, Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."

Interested in writing for us?

Read our guidelines
Share This