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1. Application Overview

2. Phone and Address Information

3. Requirements for Admission

4. Female Applicants Only: Homeless Status

5. Confidentiality Information

6. Community Agreements

7. Program FAQ

8. Orientation Information

9. Release of Information Form

10. Application to view on the web

11. PDF of all these documents to download, print, fill out, and mail

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AMETHYST HOUSE
CONFIDENTIALITY OF RECORDS
ALCOHOL AND DRUG ABUSE CLIENTS

The confidentiality of alcohol and drug abuse client records maintained by this program is protected by federal and state laws and regulations (Federal confidentiality rule 42CFR Part 2) which prohibits disclosure of information unless expressly permitted by written consent of the person to whom it pertains or as otherwise permitted by 42CFR Part 2. A general authorization for the purpose of release of medical or other information is not sufficient for this purpose. The Federal rule restricts any use of the information to criminal investigation or to prosecute any alcohol or drug abuse client.

In general, the program may not share client information outside of the Amethyst House program except inn the event of:

1. The client consents to specific disclosure in writing
2. There is receipt of a subpoena and court order, disclosure allowed by the court
3. Disclosure is made to emergency healthcare providers, qualified personnel for research, audit or program evaluation
4. Violation of the Federal and State laws and regulations is a crime and any suspected violations will be reported to appropriate authorities in accordance with the Federal regulations
5. Federal law and regulations do not protect information about suspected child abuse or neglect from being reported under the Sate of Indiana law which mandates reporting to any event in our facility
6. Federal law and regulations do not protect information about a crime committed by a client either at Amethyst House or against any person who works for the program, the program itself or about threats to commit such a crime
7. All threats to harm self or others, or crimes against children must be reported

This information is provided in accord with policies set by the State of Indiana Division of Mental Health and Addiction Services.

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Copyright: Amethyst House

E-mail: amethyst@bloomington.in.us
(812) 336-3570

Last Updated: Wednesday, October 26, 2005