![]() ![]() The victim may also be notified when deemed necessary in the treatment process or when perceived in physical danger. This consent authorizes Family Focus Counseling Services to contact the victim when I begin the program, if I am terminated from the program, and when I have completed the program. ![]() I understand these records are protected under Federal and State confidentially laws and cannot be disclosed without my written consent. I allow Family Focus Counseling Services to receive confidential information on my history of drug/alcohol use while in treatment. This consent and authorization allows Family Focus Counseling Services to obtain such information as it relates to my emotional, mental, or physical health: medical records, school records, court records and current legal charges. to release or receive information that concerns my involvement with the program here or background information useful to my treatment. Here by authorize Family Focus Counseling Services, P.C. ![]() I have received a copy of this notification of my rights and have been offered assistance in understanding them. ![]() This person will assist you in further understanding of your rights and, if necessary, will assist in an inquiry as to your concern. If you need further assistance, the Virginia Department of Behavioral Health & Developmental Services provides an Advocate for you. FIDDLEHEAD FOCUS FULLFull details of the complaint procedures may be obtained from any staff member. If unresolved to your satisfaction, an appeal may be made directly to the Local Human Rights Committee. Complaints brought to our attention will be addressed in a timely manner and resolved as quickly as possible. If you feel that any of these Rights are being violated or infringed, you are encouraged to bring your concern to the attention of any staff member with whom you work, the Supervisor or Director of the program you attend, or any other employee of Family Focus Counseling Services.
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