Statement of Understanding
Profile Employee Assistance Program (“EAP”) offers assessment; short-term outcomes-based counseling & referral services to employees and their eligible family members (“Client”) of participating companies and/or organizations (“Employer”). Services provided within the EAP counseling benefit are provided at no direct cost to the Client. It is the responsibility of the Client to pay for any services outside the EAP counseling benefit. The duration of the counseling sessions depends on the Employer’s contract with EAP.
EAP provides a 24-hour crisis line to handle after-hour emergencies.
The crisis line can be accessed by calling (1-800-645-6571).In some locations, EAP uses a web-based outcome counseling tool. At the beginning of each session, the Client will be asked to complete a brief questionnaire that will allow EAP to measure the Client’s success in counseling. This web-based tool is compliant with industry standard security practices.
Client Rights
Information the Client provides to EAP will not be released without Client’s prior knowledge and written consent except under the following circumstances: EAP counselors may be required to and will report threats of imminent physical violence or suicidal intent as well as suspicion of child/elder abuse or neglect, or if Client falls under the Department of Transportation (DOT) and presents a risk to public safety. Client’s EAP counselor may also consult or share clinical information with other Profile EAP counselors or with contracted (Profile EAP) counselors when necessary to assure quality clinical services.
Management Referrals are subject to different standards. A management referral is a request or requirement from Client’s Employer, supervisor or manager. Client will be asked to complete and sign additional forms if formally referred by Client’s Employer.
Upon request, Client is entitled to information about the methods of counseling, the techniques used, the duration of counseling, information regarding educational degrees, clinical training & experience, licenses & credentials of Client’s EAP counselor. When requested in writing, a treatment summary will be provided at Client’s expense. Client may terminate counseling at any time.
To file a complaint about EAP, Client may call the “CommonSpirit Integrity Helpline” at 1-888-424-2458 or go to
www.integrityhelpline.org. If Client speaks a language other than English or Spanish or requires visual or hearing assistance to file a complaint, Client’s EAP counselor will contact the Colorado Department of Regulatory Agencies (DORA) to assist Client with Grievance Procedure.
Client Responsibilities
I understand that if I am unable to keep an appointment, I will call 24 hours in advance to cancel or reschedule my appointment. Failure to do so will be considered a “no show” and will be counted towards my EAP counseling benefit for that year. If I arrive more than 15 minutes late for an appointment, I understand that I may be asked to reschedule my appointment. Late arrival appointments which are rescheduled will not count as a session. Late arrivals may be offered a shortened counseling appointment depending on the counselor’s availability. Those appointments will count as a session.
I understand it is EAP’s policy not to participate in legal actions such as custody suits, divorce proceedings, personal injury suits, etc. If I am considering or are involved in such actions, my EAP counselor will direct me to contact a professional experienced in legal matters, at my own expense.
I understand that EAP will not complete FMLA paperwork, return-to-work paperwork, or disability paperwork but may work with my health care professional or established EAP Counselor, if needed.
I understand that my records may be transferred electronically. I understand that my participation in EAP counseling is voluntary and that all my records are protected by confidentiality regulations.
I have read this form and understand my rights and responsibilities as a Client. I hereby give my permission to have EAP follow-up upon completion of services to assess my satisfaction.
Telehealth Counseling and Electronic Medical Records (EMR)
EAP uses “EAP Expert” as our EMR. EAP does not use “EPIC” (EMR for CommonSpirit) to schedule or document sessions. Both CommonSpirit Health and Profile EAP use CommonSpirit Health Virtual Care (CHVC) for Telehealth. For confidentiality, EAP uses a separate platform than CommonSpirit Health. Though platforms are separate, providers using CHVC will be able to view other providers and related medical services. Therefore, your EAP visit(s) will show up in your treating providers list in CHVC, treatment history section, as a “specialty provider” appointment with the name of the EAP counselor you saw. To further protect your confidentiality and minimize the information available to other providers using CHVC, EAP recommends not filling out the “reason for your visit” and not opting to share your visit summary. No other information will be available to your treating provider.
I have read and understand the above information. A Copy of this form is provided upon request.