Nancy Shaw, MA,​ LCPC, NCC, BC-TMH

Soulpath ​​Counseling Services, Inc.

 


Use of Electronic Communication Consent Form


Risk of Using Electronic Communication (EC)


Transmitting personal/counseling information by electronic communication (email, text, etc.) has a number of risks that you the client should consider. These include, but are not limited to:

  1. EC can be circulated, hacked, forwarded, stored, altered, printed or redistributed to other parties.
  2. Senders can unintentionally misaddress, thus sending to the incorrect recipient.
  3. Backup copies may exist even after the sender or recipient has deleted his/her copy.
  4. Online services, homeland security, etc. have certain rights to online property.
  5. EC can be intercepted, altered, forwarded or used without authorization or detection.
  6. EC can be used to introduce viruses into computer systems.
  7. EC can be used as evidence in court (EC becomes a part of the client record).
  8. Soulpath Counseling Services/Nancy Shaw, LCPC does not encrypt or otherwise disguise EC which can result in a breach of confidentiality.

Conditions for the Use of Electronic Communication at Soulpath Counseling Services/Nancy Shaw, LCPC


As your clinician, I will use EC only with prior permission and consent from you, the client. I cannot guarantee full confidentiality should you choose to communicate via EC. I am not liable for the improper disclosure of confidential information that is not caused by my own intentional misconduct. You must acknowledge and consent to the following conditions:

  1. EC is not appropriate for urgent or emergency situations. I cannot guarantee that any particular EC will be read and responded to within any specific time period.
  2. EC is not appropriate for discussion of your, the client’s diagnosis, treatment, progress, etc.
  3. If I believe the content of an EC is sensitive, I will respond by other means.
  4. All EC will be printed and kept in the client file.
  5. You should never use EC to discuss medical, sensitive or personal information.
  6. I am not liable for breaches of confidentiality caused by you or any third party.
  7. I will not forward any identifiable EC without your prior written consent, except as authorized or required by law.
Instructions for Communicating Electronically
  1. Avoid the use of your employer’s property
  2. Use your first name and initial of your last name in the body of the EC.
  3. Take precautions to preserve your confidentiality.
  4. Do not use EC for non-professional issues such as jokes, political messages, solicitations, etc.