Client Rights and Responsibilities
Informed Consent
Mission: To improve the quality of life for survivors of traumatic brain injury and for their families
Eligibility: Available to residents of Alabama who have experienced neuro-trauma with resulting brain and/or spinal cord injury
Client Rights: As a client of Alabama Head Injury Foundation, you have the right:
1. To be treated with respect and dignity and in a culturally sensitive manner
2. To be provided assistance with any communication barriers which make it difficult for you to receive services
3. To be free from discrimination while receiving services
4. To terminate services at any time
5. To be free from exploitation for the benefit of staff
6. To report complaints/grievance
7. To confidentiality as defined by policy and law. Alabama Head Injury Foundation maintains a strict policy on the confidentiality of your records (written and electronic). All information you share, or what we become aware of through our work with you will remain confidential.
There are some circumstances in which this policy becomes void, and Staff is required by law to release information:
a. If we become aware through our work that you may be a danger to yourself or others
b. If we become aware of or suspect child abuse or neglect
c. If we become aware of or suspect abuse or neglect to a vulnerable adult
d. If we are court ordered to testify or to submit records for court
In the above situations (a-d), I would be required to inform the appropriate authorities.
1. To be treated with respect and dignity and in a culturally sensitive manner
2. To be provided assistance with any communication barriers which make it difficult for you to receive services
3. To be free from discrimination while receiving services
4. To terminate services at any time
5. To be free from exploitation for the benefit of staff
6. To report complaints/grievance
7. To confidentiality as defined by policy and law. Alabama Head Injury Foundation maintains a strict policy on the confidentiality of your records (written and electronic). All information you share, or what we become aware of through our work with you will remain confidential.
There are some circumstances in which this policy becomes void, and Staff is required by law to release information:
a. If we become aware through our work that you may be a danger to yourself or others
b. If we become aware of or suspect child abuse or neglect
c. If we become aware of or suspect abuse or neglect to a vulnerable adult
d. If we are court ordered to testify or to submit records for court
In the above situations (a-d), I would be required to inform the appropriate authorities.
Informed Consent
Services are a collaborative process between you and the Support Specialist to work on areas identified for the purpose of assistance and improvement in those areas. For services to be most effective, it is important that you take an active role in the process.
Confidentiality: Information obtained in the session or in written form will not be disclosed to any outside person(s) of Alabama Head Injury Foundation or another agency without your written permission, except when such disclosure is necessary to “protect you or someone else from imminent harm” or is otherwise legally required and/or allowed by law (such as abuse of a child, elder or disabled person or court order). If you are under 18, your parents or legal guardian(s) may have access to your records and may authorize release to other parties.
Social Media: It is our policy to not connect with our clients through personal social media (such as Facebook, Twitter, MySpace, etc). I will not be able to accept any personal request to “friend” or “follow” you from these sites. However, if you desire to connect with Alabama Head Injury Foundation, we invite you to join our company page, which is open to the general public. Please note that we will not acknowledge nor address any concerns related to your personal treatment on these public sites. Support Specialists must document in record rationale for lack of adherence to this policy.
Electronic Transmission: We cannot ensure the confidentiality of any form of communication through electronic media. You are advised that any email sent to Alabama Head Injury Foundation via a computer in a work-place environment is legally accessible by an employer.
Records: We are required to maintain records of each time we meet or talk on the phone. These records include a brief synopsis of the conversation along with any observations or plans for the next meeting. Your records will be maintained for 7 years. After this time, your record will be shredded and disposed of if no further contact is made.
Appointment Reminders: Appointment reminders can be sent by phone, email, or text. Standard texting fees may apply. Please specify which of these we can contact you by. Please check each box that applies.
Confidentiality: Information obtained in the session or in written form will not be disclosed to any outside person(s) of Alabama Head Injury Foundation or another agency without your written permission, except when such disclosure is necessary to “protect you or someone else from imminent harm” or is otherwise legally required and/or allowed by law (such as abuse of a child, elder or disabled person or court order). If you are under 18, your parents or legal guardian(s) may have access to your records and may authorize release to other parties.
Social Media: It is our policy to not connect with our clients through personal social media (such as Facebook, Twitter, MySpace, etc). I will not be able to accept any personal request to “friend” or “follow” you from these sites. However, if you desire to connect with Alabama Head Injury Foundation, we invite you to join our company page, which is open to the general public. Please note that we will not acknowledge nor address any concerns related to your personal treatment on these public sites. Support Specialists must document in record rationale for lack of adherence to this policy.
Electronic Transmission: We cannot ensure the confidentiality of any form of communication through electronic media. You are advised that any email sent to Alabama Head Injury Foundation via a computer in a work-place environment is legally accessible by an employer.
Records: We are required to maintain records of each time we meet or talk on the phone. These records include a brief synopsis of the conversation along with any observations or plans for the next meeting. Your records will be maintained for 7 years. After this time, your record will be shredded and disposed of if no further contact is made.
Appointment Reminders: Appointment reminders can be sent by phone, email, or text. Standard texting fees may apply. Please specify which of these we can contact you by. Please check each box that applies.
Cancellation: If you find it necessary to cancel an appointment, please contact your Support Specialist at least 24 hours in advance.
Emergencies: If an emergency situation for which you feel immediate attention is necessary, please contact emergency services (911) immediately or go to your nearest hospital emergency room.
Alabama Head Injury Foundation: As Alabama Head Injury Foundation provides services, it is expected:
- That the consumer will be on time for appointment, or will call in advance and cancel or reschedule;
- That consumer will participate in planning and follow through;
- That consumer will report any benefits or services applied for and/or received from any other agency;
- That consumer will not exhibit abusive, threatening, or assault behaviors;
- That consumer will not be under the influence of drugs and/or alcohol during services;
Emergencies: If an emergency situation for which you feel immediate attention is necessary, please contact emergency services (911) immediately or go to your nearest hospital emergency room.
Alabama Head Injury Foundation: As Alabama Head Injury Foundation provides services, it is expected:
- That the consumer will be on time for appointment, or will call in advance and cancel or reschedule;
- That consumer will participate in planning and follow through;
- That consumer will report any benefits or services applied for and/or received from any other agency;
- That consumer will not exhibit abusive, threatening, or assault behaviors;
- That consumer will not be under the influence of drugs and/or alcohol during services;
I have read (or have had read to me) and understand the above information. By typing my name below and entering today's date, this is my digital consent that I have read and understand the above information.
