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Client Statement of Understanding
Access to Services
I am meeting with a NuVantage Employee Resource EAP Counselor for assessment and referral services.
After the assessment period is completed, the EAP counselor may make referrals or recommendations for ongoing counseling or to other resources in my community.
If applicable, my EAP counselor will help me to make a fully informed decision by providing me with the following information:
What services may or may not be covered by my insurance;
The length of time that should be required to access the services; and
How these services will be beneficial to me in meeting my desired outcomes as well as any potential risks or consequences to using the services.
If ongoing services are not covered by my insurance, I must make payment arrangements directly with the provider or agency if I choose to continue services.
NuVantage Employee Resource follows all federal and state regulations regarding confidentiality. Protected Health Information cannot be released without written permission unless court-ordered or otherwise mandated by law.
Portions of the client record will be kept on file for seven years and remains the property of NuVantage.
Any questions regarding confidentiality should be discussed with the EAP counselor or with NuVantage staff.
I have been advised that I can electronically access the full disclosure of NuVantage’s Notice of Privacy Practices at
. I can request a paper copy of the document by contacting NuVantage.
Every effort will be made to ensure your satisfaction and to provide you with the most appropriate level of care regarding your stated concern. If you have any questions or complaints relative to the service, you may speak with the program director by calling your toll-free access number.
Your signature below indicates you have reviewed and understand this information:
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