INTERSTATE THERAPY SERVICES ADDENDUM
Introduction:
This Interstate Therapy Services Addendum ("Addendum") is incorporated into and made part of the Therapy Intake Documentation between the undersigned client ("Client") and the therapist ("Therapist"). This Addendum serves as informed consent regarding potential interstate variations in legal requirements affecting the therapeutic relationship, particularly concerning confidentiality, privilege, and records access.
Acknowledgment of Licensure:
Client understands that while Therapist maintains appropriate licensure to provide therapeutic services, variations in state laws may affect certain aspects of the therapeutic relationship as detailed in this Addendum.
Mandatory Reporting Laws:
Client acknowledges that all states have mandatory reporting laws requiring therapists to report certain information to appropriate authorities, but these requirements vary by state.
Mandatory reporting typically includes, but is not limited to: (a) suspected child abuse or neglect; (b) suspected abuse, neglect, or exploitation of vulnerable adults; (c) imminent danger to self or others; and (d) court orders requiring disclosure.
Client understands that Therapist is bound by the mandatory reporting laws of both Therapist's licensing state and Client's state of residence, and in cases of conflict, the more stringent reporting requirement will apply.
Client acknowledges that Therapist has explained the specific mandatory reporting requirements applicable to their therapeutic relationship.
Duty to Warn/Protect Laws:
Client acknowledges that many states have laws requiring therapists to warn or protect potential victims when a client makes credible threats of violence, but the specific requirements and protections vary by state. Connecticut, California, Delaware, Florida, and New Hampshire allow disclosure in certain situations to prevent substantial damage to real property in addition to preventing harm to others.
Client understands that Therapist may be required to: (a) warn identified potential victims of violence; (b) notify law enforcement; (c) take steps to prevent the threatened harm, including potential hospitalization of Client; or (d) some combination of these actions.
Client acknowledges that Therapist will follow the duty to warn/protect laws of both Therapist's licensing state and Client's state of residence, and in cases of conflict, will follow the requirements that provide the greatest protection to potential victims.
Client Access to Records:
Client acknowledges that state laws vary regarding client access to therapeutic records, including: (a) whether clients have a right to obtain copies of their records; (b) whether therapists may provide summaries instead of full records; (c) whether therapists may withhold records if deemed potentially harmful to the client; and (d) the timeframe in which records must be provided upon request.
Client understands that Therapist will maintain records in accordance with professional standards and applicable laws, and will provide access to those records as required by the laws of both Therapist's licensing state and Client's state of residence.
Client acknowledges that requests for records must be made in writing, and Therapist will respond to such requests within 14 days, unless a different timeframe is required by applicable law.
Privacy: Gender Affirming & Reproductive Care:
Some state laws provide protections for individuals receiving, seeking, or supporting reproductive health care or gender-affirming health care, including associated mental health services. This means providers will not share your health records, billing information, or personal data with any out-of-state law enforcement or agencies seeking to penalize or investigate you for receiving care that is legal in your state. For the most up-to-date information on these laws which are always evolving, you may visit: https://www.lgbtmap.org/equality-maps/healthcare/trans_shield_laws
Federal Laws and Regulations:
Client acknowledges that certain federal laws and regulations, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA), may apply to the therapeutic relationship regardless of state boundaries.