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Directive to Protect Mental Health Information
Help Clients Protect Their Privacy After Their Death

This "Directive to Protect Mental Health Information" intends to increase the probability that clients' mental health records will stay private and confidential after their deaths and decrease the possibility that these confidential records will be accessed or reviewed by the executor of the estate, descendants, or other people or agencies.

  • This Advance Directive can be added to clients' wills, living trusts or medical wills.
  • Clients are advised to discuss this Advance Directive with the executors of their estates.
  • Therapists must explain to clients that this Directive does NOT assure that records would not ultimately be released to the executor of the estate, descendants, coroner's office, or other people or agencies who may request to review the records. Patients should understand that a coroner or other people or agencies may have the legal right to access the records and should discuss the Directive and their intentions with their attorney, their descendants, executor of their estate or other appropriate people.
  • While the form is primarily aimed for psychotherapy, counseling and other consumers of mental health services, it easily can be amended to fit the needs of other medical professions and other caregivers.
  • This form is primarily designed to be used by:
    • Psychotherapists and Counselors,
    • Psychologists, MFTs, Social Workers and Psychiatrists.
  • With minor modification, this form can also be used by:
    • Chiropractors, Acupuncturists, Dentists, Physical Therapists,
    • Physicians, Nurse Practitioners and other medical care-givers.
  • The first form is designed for California psychotherapists and the second for therapists in states other than California.

This form can purchased in 5 ways:

(Receive instantaneous printable download)

Single Copy - Single Practitioner:
Solo Practitioner: $7.00

Multiple Copies with permission to reprint:
Small Group (2-10 Clinicians): $15.00
Mid-Size Group (11-30 Clinicians): $70.00
Large Group-Agency (above 30 Clinicians): $150.00


For more Private Practice Resources, HIPAA and Packages, click here.


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ZUR INSTITUTE, LLC
Ofer Zur, Ph.D., Director
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Phone: 707-935-0655, Fax: 707-935-3918, E-mail: info@zurinstitute.com
 
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