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For this assignment you will be pretending to join a private practice in the state of your choice. You will be designing your informed consent/confidentiality disclosure form. Using the readings from the textbook, ACA Code of Ethics, AMHCA Code of Ethics, and the legislature (what your state and state licensing board mandates for required disclosure) from your state of choice you will design your form. It must include all of the essential components from the materials above. On the assignment please indicate the state you are practicing in, so I can compare the legislature to your document.

DO NOT simply copy and paste the informed consent from someone you find from the web. Turnitin is assigned for this project – you will be able to tell from your Turnitin score if you have any doubts.

For example, some of the many requirements that are mandated are as follows. Please include at least:

  • Purpose
  • Goals
  • Techniques
  • Procedures
  • Limitations
  • Potential risks
  • Benefits of service
  • Counselor qualifications
  • Credentials
  • Relevant experience
  • Continuation of services upon incapacitation or death of a counselor
  • Implications of diagnosis
  • Fees
  • Billing arrangements
  • Confidentiality
  • Limits of confidentiality
  • How to obtain records
  • Refusal of services or modality changes
  • Participation in ongoing plans

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