Confidentiality & Limits of Confidentiality of Mental Health, Alcohol &
Drug Abuse Client Records
The confidentiality of mental health, alcohol abuse, drug abuse, and/or eating disorder Client records maintained
by this program is protected by Federal laws and regulations.
The limits of confidentiality include that the program
may not say to a person outside the program that a Client attends the program or disclose any information
identifying a Client as an alcohol or drug abuser, UNLESS:
1. The Client consents in writing
2. The disclosure is allowed by a court order; or
3. The disclosure is made to medical personnel or to a qualified person for research; or
4. The disclosure is made to protect by any threats to self or others (Duty to Warn)
5. The disclosure allowed if a crime has been committed.
6. The disclosure is made for audit or program evaluation; or
7. The disclosure is made of suspected child or elderly abuse or neglect from being
reported under State law to appropriate State of local authorities.
8. The disclosure is made if any information about a crime committed by a Client
either at the program or against any person who works for the program or about any
threat to commit such a crime.
Violation of the Federal laws and regulations by a program is a crime. Suspected violations may be reported to the
appropriate authorities in accordance with Federal regulations.
Federal laws and regulations do not protect any information about a crime committed by a Client either at the
program or against any person who works for the program or about any threat to commit such a crime.
Federal laws and regulations do not protect any information about suspected child or elderly abuse or neglect
from being reported under State law to appropriate State or local authorities.
I understand that my records are protected under Federal Confidentiality regulations (42 U.S.C. 290dd-3 and 42
U.S.C. 290ee-3 for Federal laws and 42 CFR Part 2 for Federal regulations) published August 10, 1987, and cannot
be disclosed without my written consent unless other provided in the regulations. I understand that my medical
record may contain information concerning my psychiatric, psychological, drug or alcohol abuse, HIV/Acquired
Immune Deficiency Syndrome (AIDS) and/or related conditions.
Counseling and treatment is a personal and confidential relationship between a clinician and individual, group or
We work from a team approach at The Retreat of Atlanta, LLC. Therefore, there may be times when it is
necessary for us to consult with other professional staff either individually or at our clinical team meetings in an
effort to provide you with the highest consideration and quality. Our clinicians are all Mastered prepared and
professionally licensed, graduate student interns, or clinicians working toward certification in substance abuse counseling.
No information will be released from The Retreat of Atlanta regarding counseling or consultation sessions without your expressed written consent. If you wish for information to be released to anyone, it will be necessary for you to complete a Release of Information form, stipulating the professional to whom the information is being sent. The law stipulates that in the event of imminent danger to yourself or others, we must breach confidentiality. We must also act in accordance with the child protection laws of the State of Georgia.
Clients have a right inspect, copy, change, or remove their protected health information. Clients have a right to dispute any information contained in their records by bringing it to the attention of the staff.
Clients may contact the Director of Nursing for further information about our company’s privacy policies. They can be reached at (762) 366-0100
The Retreat of Atlanta Staff and patients follow the CDC guidelines for wearing a mask, hand washing regularly, and social distancing in all aspects of treatment. Patients and staff are confidentially tested if CDC signs/symptoms/temperature are present. We practice strict preventative measures.