CHEMICAL DEPENDENCY TREATMENT ASSOCIATES, INC.
Specializing in Alcohol and Chemical Dependency
Dr. Angella Barr, Dr. Michael Parr, Dr. Sandra Johnson
805 University Ave Sacramento CA 95825
Phone (916) 333-5955 Fax (916) 333-5954
Email: [email protected]
CLIENT CONFIDENTIALITY STATEMENT
Chemical Dependency Treatment Associates, Inc. (CDTA INC.) records of the Addiction Medicine Programs are kept securely and are only handled by authorized persons. Information in these records can be released only with the client’s written authorization or (in the case of a minor child) with the parent’s written authorization.
The authorization will designate the name and address to whom this information will be released, the purpose of the release, and the termination date of the authorization.
HOWEVER, STATE AND FEDERAL LAW REQUIRES THAT CDTA INC. RELEASE INFORMATION IN THESE SITUATIONS:
1. Disclosure is made to medical personnel in medical emergency or to qualified personnel for research, audit or program evaluation.
2. If you state you are going to harm another person, we are required to notify that person that they may be in danger. We may also be required to notify appropriate law enforcement agencies.
3. If you make a serious threat to harm yourself, you may be evaluated for hospital treatment even if this is against your wishes.
4. If in our contact with you we learn of any child abuse (including sexual molestation) being committed by any person, we must report this to Child Protective Services if this has not been previously reported.
5. Federal law and regulations do not protect information released to report about a crime committed by a client or threats of such a crime on the clinic premises or toward any person who works for the clinic.
6. If a court order is granted by a judge requesting alcohol and drug treatment records specifically, we must comply.
At CDTA INC. client confidentiality is very important to us, therefore to assure your privacy, we require that you agree that you will not repeat anything that you may see or hear while you are at CDTA INC. Violation of this policy will result in you being discharged from our treatment.
