
Contents
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Confidentiality Confidentiality
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Ethical Bases for Confidentiality Ethical Bases for Confidentiality
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Case Law Governing Confidentiality Case Law Governing Confidentiality
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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act
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Vignette 1 Vignette 1
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Vignette 2 Vignette 2
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Vignette 3 Vignette 3
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Exceptions to Confidentiality Exceptions to Confidentiality
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Express Waiver Express Waiver
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Implied Waiver Implied Waiver
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Duty to Protect Third Parties Duty to Protect Third Parties
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Vignette 4 Vignette 4
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Vignette 5 Vignette 5
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Civil Commitment Civil Commitment
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Suspected Child Abuse Suspected Child Abuse
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Vignette 6 Vignette 6
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Vignette 7 Vignette 7
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Suspected Abuse of Elderly or Disabled Persons Suspected Abuse of Elderly or Disabled Persons
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Vignette 8 Vignette 8
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Nonaccidental Injuries and Suspected Intimate-Partner Violence Nonaccidental Injuries and Suspected Intimate-Partner Violence
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Vignette 9 Vignette 9
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Other Exceptions to Confidentiality Other Exceptions to Confidentiality
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Psychotherapist–Patient Testimonial Privilege Psychotherapist–Patient Testimonial Privilege
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Ethical Underpinnings Ethical Underpinnings
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Case Law and Statutory Basis Case Law and Statutory Basis
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Subpoenas Subpoenas
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Vignette 10 Vignette 10
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Vignette 11 Vignette 11
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Exceptions to Testimonial Privilege Exceptions to Testimonial Privilege
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Waiver Waiver
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Patient Puts Mental Status into Issue Patient Puts Mental Status into Issue
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Danger to Self or Others Danger to Self or Others
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Conclusion Conclusion
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Frequently Asked Questions Frequently Asked Questions
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References References
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9 Confidentiality and Testimonial Privilege
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Published:March 2017
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Abstract
This chapter describes the complex medicolegal issues surrounding the rules of confidentiality and privilege and their multiple exceptions. It lays out the underpinnings of confidentiality, then addresses its various exceptions, such as waiver, duty to protect third parties, civil commitment, and mandated reporting of child abuse, elder abuse, and intimate-partner violence. Psychotherapist–patient privilege is discussed, first with regard to its origins and then with regard to its exceptions, including various forms of waiver. Practical examples illustrate these concepts for the reader to make it easier to understand these ubiquitous, but at times perplexing, concepts and to illustrate the nuances of various aspects of the law. Practitioners should note that there is considerable overlap between confidentiality and testimonial privilege, and the division of this chapter into two sections creates, in some ways, an artificial divide between two closely related concepts.
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