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Psychotherapy Release of Information Form
Psychotherapy Release of Information Form
A Psychotherapy Release of Information, ROI, form is a legal document allowing your mental health therapist to share confidential client information with specified third parties.
Such third parties can be to insurance companies as Blue Cross, Manulife, Sunlife, Canada Life, Desjardins, TD, who are approving your temporary disability insurance.
Your paid disability or long term disability will require assessment and advocation from your doctors, so we may ask your permission to share your information to involve them in your circle of care. Basically, we need this to help you get paid by your insurance when you are vulnerable.
Other examples of ROI is when a client who require car accident mental therapy may require to share their therapy work with their lawyers for compensation.
So, we need this ROI form so your lawyer can help you if you've been a victim of a car accident and it debilitates your capacity for work and in other areas.
When your ROI data is shared, the purpose, expiration date, must be included and signed by you or your guardian if you are not of legal age.
Therapy Release of Information Form
Therapy Release of Information Form
Mandatory elements required for a valid disclosure under health privacy laws of ROI.
Identification - Name, DOB, Address
The Who - Authorized parties)
The What - Scope/Detailed records
The Why - Purpose
The Timeframe - Expiration and the right to cancel
The Consent - Signatures
The Exceptions - Limits of confidentiality
This is to provide our clients the essential bases for your understanding of ROI and our legal compliance as mental health providers. Thank you.
Lee Park, RCT 25-002, MA, BHons
Owner, Canada Online Therapy
lee(at)canadaonlinetherapy.com
Phone: (514) 746 4673 Fax: (800) 808 6629
Registration is Now Open for New Clients
Registration is Now Open for New Clients
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