LIMITED HIPAA WAIVER

Client confidentiality is protected by law. As a therapist I work to ensure that clients are aware of the risks and policies associated with non-HIPAA compliant communication.  There are some additional things you need to know regarding technological tools. While convenient, email and text messaging services have inherent risks, and content sent through these modes of communication cannot be guaranteed to remain confidential. Please read this document carefully. Your signature indicates that you have read, understood, and agreed to waive your rights to HIPAA-secure communication via text, email and gaming configurations. You do not have to sign this document to communicate with your therapist. If you decline to sign this waiver, your therapist will only communicate with you via HIPAA-secure methods of communication, which, while more secure, may be less convenient and limit your therapist’s ability to respond to you in a timely manner. Please contact your therapist via phone call if you have any questions or concerns before signing this document.

• Email and texting are not appropriate for urgent or emergency situations. Your therapist cannot guarantee that any particular email and/or text will be read and responded to within any particular period of time. Please dial 911 in case of emergency or 988 in case of mental health emergency
• Your therapist is not liable for breaches of confidentiality caused by the client/guardian(s) or any third party.
• Your therapist cannot guarantee security and confidentiality of email and text information sent and received, but will use reasonable means to maintain it. Your therapist is not liable for improper disclosure of confidential information not caused by their intentional misconduct.
• Email and texts can be used as evidence in court.
• It is the client’s/guardian’s responsibility to follow up and/or schedule an appointment if warranted. If you have not received a confirmation from your therapist regarding a cancelled or scheduled appointment, it is best to consider the appointment status to be unconfirmed and it is your responsibility to follow up. 

Play has been used to increase therapy outcomes for decades, and video gaming is no exception. As a reminder: therapy is the focus and play is a therapy aid. There may be technology deemed useful to use with you in the course of our treatment, which is too new, changes frequently, or was not designed to be used clinically, and which does not comply with HIPAA standards. These include but are not limited to:

• Digital games used for play therapy (e.g. Xbox, Nintendo handhelds, Playstation, PC games, etc).

• The platforms that provide digital games such as STEAM, Activision, Facebook, etc.

• Smartphone Apps

• Text messaging over Wi-Fi

• Historical data of usage/gameplay

If you consent to work with any of these technologies, I ask that you agree to a limited waiver of your HIPAA rights to privacy and understand although I will try with all due diligence to protect you and your privacy during and after using the the technologies, I will be limited in my ability to do so. Some examples include:

• Knowledge of time spent and types of online play

• Images associated with linked accounts such as social media accounts

• Suggestions on content based on having received “cookies”

• Attempts to contact me on unsecure platforms and my response, or lack of response, to them

• Shared records of chat conversations on unsecure servers

• Shared images of screenshots

Example of ways your PHI is protected during therapy that uses technology-based play: “talk” part of therapy will happen over HIPAA-compliant software and I ask that in-game voice chat volume be muted and game sound be reduced so we can participate fully in the therapeutic process. Play therapy sessions will only ever be individual, although there may be other non-therapy players on public servers.  I will never “stream” play therapy sessions on any public platform or post any pictures or recordings of play therapy sessions and I ask that you do the same. 

As always, if you have any questions or concerns, you are welcome to let me know. This waiver will expire no later than two years from the date signed and will need to be updated at that point to cover future use.

I __________________________ have read the above and agree to a limited waiver of my HIPAA rights to privacy and release EzriKai Broam, LCSW, LADC and Improving Lives of liability in using technology that does not comply with HIPAA standards for the purpose of treatment.

 

Signed: _________________________________________  Date: ________________