Every case involves risk, including the risk of loss. to disclose information to someone else (for example, another provider, clinician, or insurance company), 2) it is determined that you are a danger to yourself or others (including abuse of a child, elder, or other vulnerable population), or 3) I am ordered by a court to disclose information. Results turn on, among other things, the facts and law applicable to each unique case. The US Equal Employment Commission’s disclaimer is similar: Whatever type of website you operate, it’s valuable to include a no guarantee disclaimer like the one above to stop users taking advantage — for example, suing for errors. Thanks for downloading our free template! It includes a separate clause stating that while it covers various topics, it does not constitute advice in that discipline: If you post any type of informational content, a standard no guarantee disclaimer clause allows you to be a source of industry knowledge without any obligations to your users. LPC PROFESSIONAL DISCLOSURE STATEMENT This document contains important information, and you are asked to review and retain it for future reference. Professional Disclosure Statement Introduction ... Counseling is a personal exploration and may lead to changes in life perspectives and decisions. [Also, list more detailed and specific testimony as required by the Arizona Rules of Civil Procedure. Post-accident photographs of Defendants’ vehicle. So, using a confidentiality statement in an email is, in a way, a preventive measure designed to provide protection by informing the email recipient about the content. Follow Instagram’s example, and put a copyright notice in your site footer. Example #2 [PDF] Example #3 [PDF] Example #4 [PDF] Sample Course Content, Speaker Biographies, and Their Disclosure Statements. The Information Commissioner’s Office (ICO), which enforces global privacy laws such as the General Data Protection Regulation (GDPR) in the UK, also has a disclaimer on its site: As the ICO website discusses privacy law compliance, it must inform users that the information it provides is not legal advice, and that the external website links it provides are only for reference. Any and all custodians of record or other witnesses who are needed to establish a foundation for exhibits listed to be used at the time of arbitration or trial. If you don’t have a disclaimer, you’re potentially leaving your business vulnerable to legal trouble. The following are typical, but not exhaustive, examples of situations and circumstances under which information may be disclosed without prior consent: 1. There is a $30 fee for any returned checks. I hold a Baccalaureate degree I promise to do my best in ensuring a safe environment where you can discuss openly your experiences, thoughts, concerns, and feelings. Should any attempt be made to utilize the contents of this pleading before a jury, fairness requires that this preliminary statement also be read to the jury and that the jury be duly informed that the evidence therein was evidence available at the time of its filing. The "Lamber Goodnow Injury Law Team at Fennemore Craig, P.C." Cellphone Use/Texting While Driving Accidents. Confidentiality disclaimers explain that some content is only intended to be seen by a certain audience — for example, private information in an email. FREE 10+ Sample Disclosure Statement Forms in MS Word | PDF It explains in legal terms that the opinion of an author you publish is not the same as that of your company or organization. Services will be suspended if you are more than 30 days overdue with payment. Use a copyright disclaimer to establish ownership of original content, and prevent users from benefiting commercially from your hard work. Revised December 2016TIERForm 417 www.ethics.la.gov2.1PERSONAL FINANCIAL DISCLOSURE STATEMENT(ANNUAL) GENERAL INFORMATION. The purpose of a professional disclosure statement is to inform clients about your professional background and the limitations of your professional relationship. 1) My counselor’s individual disclosure statement 2) A copy of the fee schedule and my fee contract 3) Washington State’s Counseling brochure 4) A copy of the Privacy Practices Notice Authorization to Release Information for Billing Purposes I understand that some of my personal information may be released to my insurance company or These changes could be temporarily distressing. Payment: I accept cash and check. There are many types of disclaimers that address liabilities for different industries, activities, and content. You can put your disclaimer or disclaimers on a separate page, then link to that page in your website menu, website footer, or impressum page if you have one. Copyright examples include any creative work that comes in a tangible form. These statements vary depending on the nature of your business, but typically explain that a product or service is offered “as is” — implying that the customer or user accepts it in its current condition, including any unseen faults. 25+ Basic Non-Disclosure Agreement Examples – PDF, Word Restricting the usage and sharing of confidential and private information can be very beneficial in various circumstances and transactions. ANTICIPATED SUBJECT AREAS OF EXPERT TESTIMONY. financial transaction, such as loans or investments). TRACY G. BELL, MA, LMHC Psychotherapist 1417 NW 54th Street, Suite 407 Seattle, WA 98107 (206) 633-6367 Licensed Mental Health Counselor License # LH 60200557 Disclaimer by the State of Washington: You can put your disclaimer or disclaimers on a separate page, then link to that page in your website menu, Health Insurance Portability and Accountability Act, Federal Communications Commission (FCC) podcast disclaimer, US Equal Employment Commission’s disclaimer, Explain how your use of this material falls under the, Warranty disclaimers prevent you from being, Investment disclaimers state that you take no responsibility for how others. TRACY G. BELL, MA, LMHC Psychotherapist 1417 NW 54th Street, Suite 407 Seattle, WA 98107 (206) 633-6367 Licensed Mental Health Counselor License # LH 60200557 A: YES. The Counseling Relationship: Counseling is both a helping relationship and a process of change. This document is designed to tell you about my background, my fees, and ensure that you understand our professional relationship. Company X, Suite# 1, Street, City, Country, www.company.com. For example, they’re useful in situations where a business needs to ensure attorney–client privilege, safeguard sensitive personal data, or protect private health records. Take a holistic approach to your legal policies by customizing a terms of service template to complement and reinforce your disclaimer. Dept of Counseling and Educational Development. Fox News has a disclaimer that addresses user-generated content on its message boards and forums: The Fox News disclaimer is a good example of how a news website can benefit from the discussion created by user-generated content, but still distance itself from the views expressed. Without waiving any objections, any and all witnesses listed by Defendant in [his/her] disclosure statement and all supplements even if later withdrawn. A disclosure statement is a document that discloses a detailed outline of the terms, conditions, rules, and standards of a transaction (e.g. To recap, there are many types of disclaimers, and you need to pick one that best suits your needs. Plaintiff will supplement the names and specific testimony if it is learned, through the course of discovery, there are any eyewitnesses to the accident other than the parties themselves. The RCW 18.19.060 and WAC 246-810-031 require counselors to provide written disclosure of the following information to clients before counseling begins. All medical records and itemized billing statements pertaining to Plaintiff incurred as a result of the subject accident. Obtain consent & manage cookie preferences, Scan your website for GDPR and CCPA compliance, Informational articles on privacy law compliance & best practices, Frequently asked questions and answers about data privacy and regulations. Failure to file your Disclosure Statements by April 30, 2021, may subject you to disciplinary action, up to and including removal from your position. Disclaimers help companies protect themselves against legal claims by addressing liabilities specific to their operations. ADDITIONAL PERSONS HAVING RELEVANT INFORMATION. The NFL’s terms and conditions includes a detailed copyright disclaimer: It states that the NFL owns all the content provided through its services, and that users have no license to copy, modify, or distribute it. COVID-19 Notice: We are providing FREE consultations via phone or video conferencing for your safety and convenience. The AEA policy requires one to state explicitly that she or he does not have a conflict of interest. The world’s largest retailer has a suitably comprehensive statement that applies to both its services and its products: All sites and apps are subject to unforeseen technical issues, and warranty disclaimers like these two examples limit your liability for problems outside of your control, such as viruses and downtime. If you’re looking for more answers, here are some frequently asked questions about disclaimers: Yes, you need a disclaimer to protect your website against legal liability. This document should answer your questions about my qualifications, but feel free to ask me any questions you have and I will gladly answer them or provide you with other supporting documents as needed. the LPC Act. For websites and apps, warranty disclaimers state that the company makes no promises about the accuracy and reliability of the content it publishes. Credentials I am a Licensed Professional Counselor – Intern (LPC-Intern). Educational Background and Credentials. For example: The benefit of all disclaimers, no matter the industry, is to safeguard your business interests. Professional Disclosure Statement and Informed Consent I am pleased you have chosen me as your counselor. One effective way to do this is to place a copyright notice in your site’s footer. YouTube content creators and businesses that target children under 13 need to comply with the Children’s Online Privacy Protection Act (COPPA). your written permission.