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Western Psychological and Counseling Services Consent to Disclose Substance Use Disorder Patient Records Criminal Justice System Client Name: (please print): ___ Other names used in treatment, if any: ___ I authorize Western Psychological to exchange information regarding my treatment and participation in Western Psychological and Counseling Services, Incs Substance Use Disorder Program:Name: ___DMV___ Address:Attention: __Driver1905 Lana Ave. NE___CityState, Zip: __Salem,Oregon...
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Read the guidelines for Appendix B carefully to understand its purpose.
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Gather all necessary information about your client and the services provided.
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Fill out the identified sections with accurate client details, ensuring compliance with privacy regulations.
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Professionals or organizations working with vulnerable clients who require protection and confidentiality.
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Social workers, legal advisors, healthcare providers, or any entities needing to document client protection measures.
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Appendix B - Protecting Clients is a document that outlines the guidelines and requirements for safeguarding client information within financial and legal professions.
Professionals in the financial and legal sectors, including registered investment advisors, attorneys, and firms that handle sensitive client information, are required to file Appendix B.
To fill out Appendix B, individuals must complete the required sections detailing their client protection strategies, data security measures, and any incidents of data breaches, as instructed in the accompanying guidance document.
The purpose of Appendix B is to ensure that organizations implement adequate measures to protect client information from unauthorized access, breaches, or misuse.
Information that must be reported includes the types of client information being protected, risk assessment outcomes, data security policies in place, staff training on data protection, and any known breaches or violations.
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