ASSISTANCE PROGRAM STATEMENT OF UNDERSTANDING AND AGREEMENT ON CONFIDENTIALITY:
- ConfidentialityInformation you provide to your Assistance Program is confidential and will not be disclosed without your written consent except as set forth below:
- abuse or neglect of a child, dependent adult, or person with a disability,
- threat of bodily harm to yourself or someone else,
- as mandated by a court order or law, or
- with your signed consent.
- Please consult with your insurance or benefits representative before you access services outside of the Assistance Program provider network.
- There may be costs associated with the referrals provided that are not covered by the Assistance Program.
- Complaints of Harassment and/or DiscriminationDiscussion of concerns about potential workplace/school harassment, violations of organizational/school policy and/or discrimination with your counselor are not considered official notification to your employer/school. To do so you will need to follow your organization’s/school’s policy.
By accepting below I acknowledge that I have read and understand the above statement and that I agree to proceed pursuant to the terms set forth above.