By clicking “I Agree” below, I acknowledge that I understand that I am bound by state and federal laws related to the confidentiality of client records, including the Federal Confidentiality of Substance Use Disorder Patient Record Rules (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 Illinois Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110 et seq).

Specifically:

1. I assert that I have the right to review client information by virtue of an authorization form signed by the client specifically identifying myself as someone with a right to review such information for the purpose of provider partner services, treatment, care coordination, or other services related to the client’s relationship with TASC.
2. I understand that my rights to this information by way of an authorization form signed by the client limits me to review the information specifically identified on the authorization form and only the minimum necessary to perform my duties.
3. I understand that as a recipient of client information that federal and state confidentiality laws prohibit any further disclosure of the client information reviewed, unless further disclosure is permitted by an authorization form signed by the client or otherwise permitted by the federal and state confidentiality laws.
4. I understand that the federal rules restrict any use of this information to initiate or substantiate criminal charges against a client or to conduct an investigation of a client.
5. I understand that I shall be liable to TASC for any federal or state civil fines imposed by a court of law as a result of any violation, by myself, of this agreement or any state or federal confidentiality laws in relation to this agreement.