Confidentiality

Business Hours:
Monday thru Friday, 8:00am - 5:00pm
Appointment-Scheduling hours are Monday through Friday, 8:00am-12:00pm & 1:00pm-4:00pm
Phone: (512) 471-3515 - Student Services Building 5th Floor

Confidentiality is an essential part of any clinical relationship. All aspects of your participation in clinical services at the Counseling & Mental Health Center, including the scheduling of appointments, content of counseling sessions, and any records that we keep, are confidential as outlined by federal and state law. Please read our Consent Form and Notice of Privacy Practices which both provide more detail about how we handle your confidential information. Communication between a clinician and a client may only be disclosed when: (a) the client signs a Consent Form and/or our release of information form authorizing such disclosure, (b) in cases of immediate danger of serious harm to the client or someone else, or (c) other infrequent circumstances as described below under "Limits of Confidentiality." Counseling records are maintained in files completely separate from the student's academic records and can not be accessed by faculty, parents, or any non-CMHC staff without the client's signed authorization. Clients are encouraged to address any questions or concerns about this important issue with their clinician.

CMHC operates within professional ethical guidelines and applicable federal and state laws which protect the privacy of your mental health records. (For more information, see our Notice of Privacy Practices)

Notice of Privacy Practices
Consent
Limits of Confidentiality
Consent for Treatment of a Minor
About Your Counseling Record
Client Rights and Responsibilities
Consent Form

Limits of Confidentiality

In most cases, your written and signed authorization is required before information concerning your care can be disclosed to individuals outside of CMHC, including parents, roommates, friends, faculty, and partners. Below are some of the cases in which the law dictates that your signed authorization may not be required in order for CMHC to release information:

If a CMHC staff person believes that you are likely to harm yourself and/or another person, he or she may take action necessary to protect you or others by contacting law enforcement officers or a physician.
If a CMHC clinician has cause to believe that a child has been or may be abused or neglected, the clinician is required to make a report to the appropriate state agency.
If a CMHC clinician has cause to believe that an elderly or disabled person has been or may be abused, neglected, or subject to financial exploitation, the clinician is required to make a report to the appropriate state agency.
Information disclosed about a person from whom you sought counseling in the State of Texas behaving toward you in a sexually inappropriate manner must be reported (your identity may remain anonymous at your request).
If your records are requested by a valid subpoena or court order, we must respond.
If you are a minor (under the age of 18).

Consent for Treatment of a Minor

About Your Counseling Record

Your counseling record contains documentation relevant to your care at the Counseling and Mental Health Center ("CMHC"). It will be retained for at least seven years after your last contact for services.

CMHC and University Health Services (UHS) use a collaborative approach and therefore work closely together; therefore, my mental health record will be accessible to UHS healthcare providers and other UHS medical personnel. This sharing of information is done for my safety and to facilitate the continuity of my care. Within CMHC, your counseling record is available to staff members who have a need to access it.
Your counseling record is not a part of your academic record. If you choose to authorize release of your counseling record to an academic department, that information does become part of your academic record.
Note that information shared during a counseling session is confidential within the limits set forth in the Notice of Privacy Practices. While some of the exceptions to confidentiality are listed above, please read this document for a full description of the limits of confidentiality. Before receiving services, you must read and sign the attached Consent Form.

Your Rights

To Appropriate Treatment
A clinician may meet with you for one or two sessions to determine the kind of services that will best meet your needs, and whether we can provide those services here at CMHC. If your needs cannot be met within this agency, you will be given referrals for off-campus clinicians or other resources.
To Physical and Emotional Safety
Your clinician will do everything possible to protect your physical and emotional welfare. This includes intervening on your behalf if your well-being becomes threatened by emotional or physical stress.
To Provide Feedback to Us

You will be asked periodically to provide a more formal evaluation of the services you receive at CMHC. If you wish to comment on the services you have received, you may do so at any time. Comment forms are available at our website, at the Front Desk, and in the waiting areas. You may leave your completed comments in one of the locked boxes in the waiting area or at the Front Desk. You may also contact one of the Assistant or Associate Directors by telephone or in writing.

Your comments and your formal evaluations are essential to our continuing effort to improve the quality of our services.

Feedback regarding ethical or professional conduct may be reported to the Director or the Senior Associate Director for an internal review. Fill out this form to submit your feedback or call CMHC at 512-471-3515.

If your feedback has not been addressed to your satisfaction, then you may verify a license or file a complaint with the licensing board of the service provider involved.

Your Responsibilities

Completion of Paperwork
All students who come to CMHC are asked to complete paperwork prior to seeing a clinician for an initial consultation.
Regular Attendance
You are expected to attend and be on time for all scheduled appointments. If you are unable to attend a session, it is your responsibility to cancel no later than noon the day PRIOR to your appointment. You will be charged a $25 charge if you miss your appointment without canceling by that time. Please note that the $25 charge will appear on your UT "What I Owe" page as "CMHC No Show / Late Cancellation charge." Thus, anyone given access to that page will be able to view the charge.
Active Participation
To benefit from the services you receive, you should be prepared for your sessions, actively participate with your clinician, and carry out plans made with your clinician.
Evaluation of Services

We ask that you complete the evaluation forms provided to you, so that we can assess the quality of our service delivery.

Consent

I consent to receive treatment from CMHC clinician(s).
I have read and understand that Texas State Law permits or requires the disclosure of confidential information without my consent under very specific circumstances (see Notice of Privacy Practices).
I am giving my consent to the Counseling and Mental Health Center ("CMHC") to use my health information from my record for purposes of providing me treatment and for coordination of my care as defined and explained in more detail in the Center's Notice of Privacy Practices ("Notice"). CMHC's Notice provides more complete information about how protected health information may be used, and a copy of this Notice is available at http://cmhc.utexas.edu/confidentiality.html or at the CMHC front desk upon request. I understand that CMHC reserves the right to modify its Notice, and a revised Notice will be provided upon request.
I authorize the sharing of information among CMHC clinicians who are involved in my mental health treatment.
I understand that CMHC and University Health Services (UHS) use a collaborative approach and therefore work closely together; therefore, my mental health record will be accessible to UHS healthcare providers and other UHS medical personnel. This sharing of information is done for my safety and to facilitate the continuity of my care.
I have the right to ask CMHC to restrict how my protected health information is used to carry out treatment or health care operations. I understand that CMHC is not required to agree to my request for restrictions, but if it does, I understand that CMHC is bound by its agreement.
I may revoke this Consent Form at any time by notifying CMHC in writing of my intention to revoke it. My revocation letter will not affect any use of my health information by CMHC for treatment or health care operations before the revocation is received. The revocation letter shall be addressed to: Counseling and Mental Health Center ATTN: Records Office University of Texas 1 University Station, A3500 Austin, Texas 78712
I will be charged $25 if I miss a scheduled CMHC appointment (except group counseling appointments) without canceling 24 hours in advance of the appointment. I understand that these charges will appear on my UT "What I Owe" page, and that anyone given access to that page will be able to view the charge.

I hereby grant my permission for any counseling, testing, or diagnostic evaluation that may be deemed necessary by my clinicians. I understand that treatment is a joint effort between my clinicians and myself, the results of which cannot be guaranteed. Progress depends on many factors including motivation, effort, and other life circumstances. I agree that I will be responsible for the payment of all fees. I know that I can end treatment at any time and that I can refuse any requests or recommendations made by my clinicians.

Authorization to Receive or Release Information

Consent Form for Minors

If you are under the age of 18, Texas State Law requires that we obtain permission from your parent or managing conservator/guardian in order to offer you counseling services. Consent for Treatment of a Minor

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