Each individual has an inherent right to privacy.  InterTribal acknowledges this right and will adhere to all federal
and state laws and regulations regarding confidentiality of client  information.   

 Client:  A person will be considered a "client" of InterTribal after having applied for, participated in, or received    
and interviewed , counseling, or any other service from the Intertribal Treatment Center Client
identifying information: Is any information that would identify a client as a substance abuser, either
directly or indirectly.     

Disclosure: Any communication of information about an identified client, or that would identify someone as a client, including verification of information that is already known by the person making the inquiry.     

Records protected from unauthorized disclosure:  Any information acquired about a patient whether or not it is in writing, including the clients identity, address, medical or treatment information and all communications made by
 him or her to program staff.   

Consent:  A Consent for the Release of Confidential Information which adhere to all State and Federal regulations
will be utilized.  (attached)     

1.  Each client, upon admission, will receive information verbally and in writing, informing them of their right to confidentiality.  Receipt of this information will be acknowledged by their signature on a "Documentation of Understanding."  The original signed copy of the Documentation of Understanding will become a permanent part of the client file and a copy given to the client.  (attached)    

2.  Each client will have explained to them the need there may be for the release of information and that it is their choice, exclusively, whether or not a release need be completed.  They will also be informed as to the length of time the release is valid, the purpose for which it is to be used, to whom it is being written, and that it may be revoked at any time and that the client will not be forced, in any to validate a consent to release information if he/she chooses not to.  Signed releases become a permanent part of the client file.    

3.  Criminal Justice System referrals will be asked to sign releases of information which are irrevocable until disposition has occurred which pertain to the referring condition.  Court systems will be asked to obtain these releases prior to a client entering treatment; however, if the release has not been secured  prior to admission, InterTribal will ask the clients if they are agreeable to consenting to a release to the court system.  (attached )   

 Client Records:   

1.      All client records will be stamped "CONFIDENTIAL". 

2.      All current client records will be stored in a locked file cabinet.  The file cabinet will be marked "Confidential".     

         File cabinets will be locked at all times behind a locked office. 

·        When office is not occupied door will be locked   

·        Only designated staff will have access to files with the list posted on the file cabinet.

·        A sign in, sign out sheet for client records will be kept in the file cabinet.            

·        Staff members having client files in their possession will be responsible for strict adherence to confidentiality keeping them closed and not available for others who may be in his/her office to see.      

·        Following discharge and preceding the twelve (12) month follow-up, client files will be transferred to
 1 part folders and filed alphabetically.   Files will then be stored in a file in the resident manager’s office. This closet will remain locked at all times with only authorized personnel having access.  The closet will be marked "Confidential" and a list of staff having access to the file will be listed on the door. 

·        Client card file will be kept on each client.  While the client is a resident at the Center this card will be kept in the Confidential Room Roster.  The Room Roster will be utilized during the day by the Secretary and after 5:00  p.m. by the evening shift.        

·        Upon a client's discharge the card will be placed in the card file which will be marked "Confidential" and kept locked, except when in immediate use by designated staff.    

Re-Disclosure: Any disclosure made with client consent will be accompanied by a written statement that information disclosed is protected by federal law and that the

Recipient cannot make any further disclosures of it unless permitted by the regulation.  Sec.  2.  32 (attached).  All written information released will be stamped confidential. 

Phone Calls:  If a caller requests to speak to a client whomever answers the phone will reply, "I cannot tell you whether or not the individual you are requesting is a client here, but if he/she is, I will give him/her any message".   

Visitors:  Visitation can be arranged through the primary counselor.  If a visitor drops by unexpectedly, he/she will be asked to wait in the front lounge and the staff will notify the client that the visitor (giving visitors name) is present and if the client wishes to see the visitor the client will precede to the front lounge.  If the client does not wish to see the visitor the staff will tell the visitor that no one here wishes to visit with them. 

Court-ordered Disclosures:  Any disclosures requested through the court system will be the sole responsibility of the Program Manager. 

Research, Audit of Evaluations:  Any agency doing research, audit or evaluation must agree in writing that it will redisclose patient identifying information only:

A.     Back to the program; 

B.     Pursuant to a court order to investigate a program ­not a client; 

C.     To a government agency that is overseeing a Medicare or Medicaid audit or evaluation. Sec. 2.53.  

Program Personnel:  All program personnel and volunteers shall strictly adhere to all State and Federal Confidentiality Laws and Regulations: 

1.      Each person being considered for employment with Intertribal shall be notified that this program is required to adhere to all Federal Laws and Regulations regarding client confidentiality (42U.S.C.$$290 ee-3, 290Off-3). 

2.      Each person being considered for employment with Intertribal shall be given a copy of CFR Part 2, to be read in it's entirety, along with an Agreement of Understanding and notified that the signing of the agreement is a prerequisite of employment in which Intertribal can assure adherence to Federal Laws. 

3.      Upon employment termination whether it be the decision of the employer or employee, a copy of the original Agreement of Understanding will be given to the exiting employee, either in person during the exit interview which will be signified by a notation on the bottom of the original form and witnessed by the Program Coordinator, or by 'Certified-Return Requested' mail with the return receipt being the acknowledgement the copy of the Agreement of Understanding was received.  The receipt will become a permanent part of the employee's personnel file.   

Current Employees:  Persons hired prior to the date of implementation of this procedure; having verbally received confidentiality information have had CFR Part 2 been made available to them, having taken part in training and discussions regarding client confidentiality, and having signed a statement that they did receive and understand confidentiality (CFR-2) which was made a permanent part of their personnel file will: 

1.      Be notified with receipt of notification designated by personal signature an a witnessing signature; or by registered mail, that Intertribal is required, due to federal funding, to adhere to federal confidentiality law and regulations (42 U.S.C. $$290 ee-3, 42 CFR Part 2) regarding client confidentiality and in order for Intertribal to maintain continuity in following procedures
 regarding confidentiality, all employees will be required to comply to current policies (notification attached). 

2.      Current employees shall be given a grace period of one (1) week in which to meet the requirements regarding steps 2 and
 3 of the procedure for employees, or to notify the Program Coordinator, in writing before the end of the one (1) week grace period, that choose not to comply with current procedures regarding client confidentiality. 

3.      Current employees who choose not to comply with current procedures must be considered as willingly desirous of or actively breaching client confidentiality and, having received notification of such, shall be terminated immediately so as not to put Intertribal in libelous situation risking fines of loss of funding.  

Disclosures without Consent 

Medical Emergencies:  Program staff may release client information without a consent to release if a medical emergency situation exists which involves an immediate threat to the health of any individual.  Uncontested disclosures in medical emergencies may be made only to medical personnel.  Detailed information will be documented in the clients record by the staff person disclosing the information which includes:           

·        Name and affiliation of the recipient of the information;

·        Name of individual making disclosures; and

·        Nature of the emergency 

This entry will also be reviewed and signed by the Program Director. 

Patient Crimes on Program Premises or Against Program Personnel:  When a patient has committed or threatened a crime on program premises or against program personnel, program staff are allowed to report the crime to a law enforcement agency or seek its assistance.  Program staff may disclose the circumstances of the incident, the suspect's name, address, last known whereabouts, and status as a patient at the program according to Sec. 2.
12 ( C ) (5). 

Child Abuse and Neglect:  Initial knowledge of child abuse and neglect must be reported to appropriate state or local authorities preserving confidentiality to the maximum extent possible.  A definable reason must exist which indicates suspect of actual or imminent harm to the child.  Reporting of abuse and neglect will be the responsibility of the Program Coordinator in compliance with all State and Federal regulations.  Staff members will notify the Program Coordinator if child abuse or neglect situations exist and enter documentation in the clients file.  Upon completion of the reporting process, the Program Coordinator will enter a notation in the client file. 

Elder Abuse and Neglect:  Initial knowledge of elder abuse and neglect must be reported to appropriate state or local authorities preserving confidentiality to the maximum extent possible.  A definable reason must exist which indicates suspect of actual or imminent harm to the elder.  Reporting of abuse and neglect will be the responsibility of the Program Coordinator in compliance with all State and Federal regulations.  Staff members will notify the Program Coordinator if child abuse or neglect situations exist and enter documentation in the clients file.  Upon completion of the reporting process, the Program Coordinator will enter a notation in the client file.  

            Duty to Report: When a counselor determines that a clear and imminent danger

            Exists to a client or some third person, for example, the counselor clearly has an

Ethical obligation to disclose that information, even if it is otherwise confidential, to the proper authorities as
 well as to the potential victim and referring agencies. 

All Federal and State Regulations regarding Confidentiality must be strictly adhered to.  A copy of the "Guide to the
 New Federal Regulation on Confidentiality" will be kept in the front office of the Intertribal Center for reference, for all staff  to use.  If any question regarding client disclosure arises, the final determination will be made by the Program Coordinator.