The Summit Counseling Center and the center and/or therapist providing counseling services (the “Provider”) are committed to patient and family confidentiality, and they comply with applicable law (e.g., HIPAA) and guidelines to protect the privacy of healthcare information. CURE authorizes sessions for participants utilizing a limited release of protected health information This does not authorize the Providers to disclose clinical information to CURE regarding patients or their families.
CURE Childhood Cancer offers the Program solely to support patients with childhood cancer, LCH, HLH, or aplastic anemia, as well as the families of such patients. While CURE has chosen to partner with an accredited center with state-licensed Providers, CURE has no responsibility for, and makes no representations or warranties with respect to, a) the actions or inaction of Providers who render counseling and other services through this Program, including, but not limited to, any action taken by such Providers based on their perceived or actual legal or ethical obligations to report to legal authorities or other third-parties information obtained during the course of providing services as a part of the Program; b) the information provided by the Providers in any form, whether printed or electronic; c) the quality or outcome of services provided through this Program; or d) the ability of Providers to provide the contracted services, including any express, statutory, and implied warranties of treatment outcome. CURE reserves completely the right to alter the type and nature of the programs or services offered. By participating in the Program, patients and their families agree to hold CURE harmless for any breach of professional liability while receiving services from Providers.
By submitting this form, I give CURE Childhood Cancer permission to provide my name, contact information, and limited health information regarding the child with cancer to the Providers providing counseling services. By submitting I am also stating that I have read and understand these Guidelines and the Disclaimer provided above.