Privacy of Information Shared in Counseling/Therapy: Your Rights and My Policies

What to expect: The purpose of meeting with a counselor or therapist is to get help with problems in your life that are bothering you or that are keeping you from being successful in important areas of your life. You may be here because you wanted to talk to a counselor or therapist about these problems. Or, you may be here because your parent, guardian, doctor or teacher had concerns about you. When you meet with the therapist, you’ll discuss these problems. The therapist will ask questions, listen to you and suggest a plan for improving these problems.

As a general rule, your therapist will keep specific and detailed information you share in your sessions confidential, unless you have provided your consent to disclose certain information. However, your therapist will sometimes share general information about your care to your parent or guardian and may in some situations, when permitted by health care privacy laws, share additional information about your care with your parent, guardian or in rare situations, another person. The following are some examples of when this may occur:   

• Your therapist determines in his or her professional judgment, that sharing the information with your parent or guardian is in your best interests and allowed under applicable law.  

• Your therapist is legally or ethically required (under the ethics guidelines of his or her profession) to share information with your parent or guardian or another person in order to protect you or someone else from harm.  For example, if you discuss a plan to cause serious harm or death to yourself or someone else who can be identified, your therapist may need to disclose this information to your parent, guardian or the person who is at risk of being harmed.   

• You disclose you are being abused physically, sexually or emotionally or that you have been abused in the past. In this situation, your therapist may be required by law to report the abuse to the state’s Department of Social Services. 

• You are involved in a court case and the court requires your therapist to disclose information about your counseling or therapy.  

 The law requires your therapist to share information with your parent or guardian about your care.  For example, in some states and in some situations, state law may require your therapist to share your therapy record with your parent.

Your therapist will otherwise comply with all applicable laws and the Notice of Privacy Practices provided to you or your parent/legal guardian with respect to your PHI. This includes using and disclosing your treatment information, but not detailed notes by your therapist, for treatment, payment, and health care operations.

Permission to Treat:   By completing your registration through www.plushcare.com or plushcare.com, you give permission to the Providers to provide you with medical care. You may withdraw this consent at any time by no longer seeking care from PlushCare, Inc. and PlushCare of California, Inc., P.C. (“PlushCare”) or by providing notice to PlushCare of such withdrawal. PlushCare has the right to refuse access to the service to any person at any time, for any reason, or for no reason at all.

Telehealth, sometimes referred to as telemedicine, involves the delivery of health care services using electronic communications, information technology, or other means between a medical provider and a patient who are not in the same physical location. Telemedicine may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to:  

• Electronic transmission of medical records, photos/images, personal health information, or other data between a patient and a medical provider; 

• Interactions between a patient and medical provider via audio, video, and/or asynchronous data communications; and 

• Use of output data from medical devices, sound, and video files.

Telehealth services are not a substitute for in-person health care in all cases. As with any medical service, there are potential risks associated with the use of telehealth.

By creating an Account and/or accessing the services, you acknowledge that you understand the risks and benefits of telehealth, you have received adequate answers to any questions you have about the use of telehealth, and you consent to the use of telehealth in the delivery of health care services to you.

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Adolescent Consent Form & Parent Agreement to Respect Privacy

Adolescent therapy client:

Signing indicates that you have reviewed the policies described above and understand the limits to confidentiality. If you have any questions as we progress with therapy, you can ask your therapist at any time.

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Parent/Guardian:

Signing indicates your agreement to respect your adolescent’s privacy: 

• I will refrain from requesting detailed information about individual therapy sessions with my child. I understand that I will be provided with periodic updates about general progress, and/or may be asked to participate in therapy sessions as needed.  

• I understand that I will be informed immediately about situations that could endanger my child. I know this decision to breach confidentiality in these circumstances is up to the therapist’s professional judgment and may sometimes be made in confidential consultation with her consultant/supervisor.