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Content and documentation of training

(On your letterhead)

Checklist for staff training in local laws and professional ethics

Dear Employee,

When people come to this practice for evaluation or treatment of their or their relatives or childrens mental
health or developmental concerns they are likely to discuss very personal information which they want to
remain confidential - to be known only to themselves and the therapist or clinician who is treating them. In
the pages below we describe our offices rules designed to protect the confidentiality of all clients healthcare
information and any other confidential information in this office. You should assume that everything is
confidential in this office and treat it accordingly.
As a condition of your employment we require that you read, understand, and agree to comply with these
rules.
A checkmark below indicates that I discussed the topic with those present on this date: _____________. I,
____________________ , conducted this training.
q
The codes of ethics and guidelines of my profession.
q
The main malpractice and ethics issues and risks - confidentiality, dual relationships, billing, and
_______________________________________________________________ .
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Procedures and limitations on releasing any kind of records.
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Procedures for photocopying records.
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How to respond to phone calls about clients.
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The organization, handling, and storing all paper material with clients names - charts, forms,
photocopies, faxes, voice mail boxes, appointment books, phone messages and books, etc.
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Proper use of computer programs which contain client information in order to maintain its privacy.
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Not using clients names on the phone, in the waiting area or elsewhere where they could be overheard
by unauthorized persons.
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Privately playing the answering machine or calling the answering service.
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Casual conversations and gossip about clients, in and out of the office.
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How the confidentiality of clients information extends after the death of the client or the professional,
after my leaving this employment, and into the future indefinitely.
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That breaking confidentiality rules is grounds for immediate dismissal.
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How to handle questions of ethics, confidentiality, access, etc. raised by clients, other professionals, or
by situations.
My signature below indicates that I have read and discussed:
q
q

This offices Information for Clients brochure or the other routes to informed consent.
Other client education materials of this practice (such as the Limits of Confidentiality handout and the

Managed Care handout) as appropriate to my job functions.

q
The NPP, Consent, and release forms, as appropriate to my job functions.
I have been informed about the above issues and guidelines, had the opportunity to raise any questions, and
have had my questions answered. I believe I understand the issues and concerns about confidentiality and
related issues and will ask the Privacy Officer, __________________________ or _________________________
when any questions or concerns arise for me.
I agree not to disclose any client information to third-parties, persons outside this
practice/office/organization, other clients, or anyone else unless authorized to do so, in writing, by the client
(or clients personal representative) and approved by my employing professional.
If a breach of this agreement or the confidentiality of any records should occur I agree to notify my employer
immediately and within no more than 24 hours of its discovery.
I understand that any material breach of this agreement shall constitute good cause for my discharge from
this employment. In addition, such breach may subject me to liability and legal damages.
_______________________________

__________________________ ___________

Signature of employee

Printed name of employee

_______________________________

__________________________ ___________

Signature of employee

Printed name of employee

_______________________________

__________________________ ___________

Signature of employee

Printed name of employee

_______________________________

__________________________ ___________

Signature of employee

Printed name of employee

Date

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