This confidentiality agreement is designed to protect the privacy and confidentiality of the child/teen enrolled in Bend Health’s Virtual Intensive Outpatient Program (IOP) while allowing for the involvement of family members and/or support persons in the treatment process.

This confidentiality agreement applies to all family members and/or support persons who will be involved in the treatment process of the child/teen enrolled in our IOP.

Agreement:

• I understand that as a family member and/or support person of a child/teen enrolled in the IOP, I may have access to confidential information related to the child/teen's diagnosis, treatment, and progress.
• I agree to maintain the confidentiality of all information disclosed to me about the child/teen's treatment, including but not limited to:
  • The child/teen's diagnosis, treatment plan, and progress
  • Discussions that occur during family therapy sessions
  • Information shared during individual therapy sessions, group therapy sessions, and other aspects of the treatment process
  • I understand that the confidentiality of the child/teen's treatment information is protected by state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA).
• I agree not to disclose any information related to the child/teen's treatment to anyone without the child/teen's written consent except as required by law or to prevent harm to the child/teen or others.
• I understand that if I breach this confidentiality agreement, I may be held liable for any damages that result from my breach.
• I understand that the child/teen may terminate my involvement in their treatment process at any time and that I must comply with their wishes to discontinue my involvement.
• I understand that if I have any questions or concerns about the child/teen's treatment or my involvement in the treatment process, I should contact the child/teen's treatment team for guidance.
• I agree to sign and adhere to any additional confidentiality agreements or policies that may be required by the treatment team or our Bend Health.