Phone: (502) 452-9227
Fax: (502) 452-1529
www.stueckerandassoc.com
STATEMENT OF UNDERSTANDING
The
Employee Assistance Program (EAP) is a counseling resource for employees and
their immediate family members who need help in resolving personal
problems. The EAP costs you nothing.
Your employer pays for the EAP. If
additional professional help is needed, the cost is your responsibility.
Our EAP counselors are licensed and professionally trained. Please feel free to ask your counselor about his/her individual qualifications.
q I understand that the EAP counselors do not have the authority to excuse employees from work or to recommend that an employee take time off work because of personal problems. Only the Employee's physician can do this.
q I understand that the EAP will not substitute for court-ordered treatment of any kind.
q
q I understand that the EAP will not write letters on my behalf or voluntarily release information to courts, attorneys or agencies to support employee claims regarding leave time, disability, workers’ compensation, custody or any other issue.
q I will not attempt to use my EAP participation in any related process or any court proceeding.
q I understand that if I am unable to keep an appointment, I will call at least 24 hours in advance to cancel or reschedule, or it may be counted as a visit.
q I understand that all my visits do not need to be used at one time. The frequency of appointments is determined by my need.
q
I give my permission to
q I understand that I am not permitted to bring weapons of any kind on the premises.
q I understand that the only exceptions to confidentially are in those situations that are life threatening, that involve child abuse or neglect, or the abuse of a vulnerable adult.
q I have received a notice of the HIPAA regulations of Privacy Practices, which describes how Stuecker and Associates Inc. may use my health records.
Signature Date
This facility is in compliance with Confidentiality
of Alcohol and Drug Abuse Patient records, 42 C.F.R Part 2: the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), 45 C.F.R. Parts 160 & 164; and the
Mental Health Code, Section