Forms and Policies

ConFIDENTIALITY POLICY

Information shared in the context of mental health treatment is confidential. To provide the best possible care to patients, we conduct clinical consultations and coordination of care within SHWB MHS, as well as with healthcare providers within Student Health and Well-Being Primary Care (SHWB PC). Information between primary care and mental health providers is shared only when relevant to treatment, including but not limited to clinic visit notes, appointment history, plan of care, prescription medications, diagnosis(es), and relevant laboratory tests. Information will not be disclosed outside of SHWB MHS and SHWB PC without your written permission unless as required or permitted by law.

Policy and information about Treatment of Attention deficit disorders (adhd)

The treatment of attention deficit disorders (ADHD) commonly requires medications that are controlled dangerous substances (CDS). Practitioners within the MHS and PC practice may provide consultation, clinical diagnosis and treatment of ADHD under a protocol designed to provide safe use of medications, equitable access to treatment, and mitigation against unlawful diversion of medicines. Developing a treatment plan includes utilizing a clinical diagnostic interview, multimodal assessments (including a combination of objective and subjective evaluation) and collateral information from previous treating providers, family, or other relevant sources. In cases where diagnosis is unclear, a provider may administer or recommend additional assessments. The ADHD protocol was developed to mitigate health disparities that result in lack of affordable or equitable access to diagnostic assessment resources or treatment. Students and learners who wish to pursue treatment for ADHD should schedule an Initial Consultation appointment to discuss their concerns and learn more about the assessment and treatment options.

Student Health & Well-Being Mental Health Services Consent Form

The Johns Hopkins University Student Health and Well-Being Mental Health Services organization (SHWB MHS) provides mental health treatment and well-being support to Johns Hopkins University students and learners at locations in our Baltimore and Washington D.C. area campuses. The SHWB MHS includes several clinic locations and entities at Homewood (Counseling Center), East Baltimore, Washington DC, Consultation Services, and the Johns Hopkins Behavioral Health Crisis Support Team (BHCST). The SHWC MHS consent form can be found here.

Privacy Practices Notice

Notice of Privacy Practices for the division of Johns Hopkins University Student Health and Well-being.  This notice described how personal health information about you may be used and disclosed and how you can get access to this information. The Privacy Practices Notice can be found online in this PDF document.

Release of Information

Mental Health Services does not disclose any information about a client without written permission (please see our Confidentiality Policy). If you would like someone to be able to communicate with Mental Health Services about your treatment, you must fill out a Release of Information form. You may come in to one of the clinics and fill one out or you may print it from this website, fill it out at home and bring it to Mental Health Services, or fax the completed form to the clinics.

Release of InformatioN (specific to WellFleet)

As stated above, Mental Health Services does not disclose any personal health information without written permission. Students who are enrolled in the JHU student health benefit plan, which is administered by Wellfleet Group, LLC and contracted with Cigna, may wish to grant Mental Health Services permission to submit a Referral Authorization form on your behalf. The Referral Authorization form notifies the insurance company that Mental Health Services has referred you to a community mental health provider and will reduce your $150.00 insurance deductible to $75.00. Once submitted, a copy of the Referral Authorization form will be sent to you via email for your record and in case your new mental health provider wants documentation verifying your reduced deductible eligibility.

If you would like the Mental Health Services staff to communicate with Wellfleet and reduce your deductible, you must fill out this Release of Information for WellFleet form.  You may come in to one of the MHS clinics and fill one out or you may print it from this website, fill it out at home and email it to [email protected].

Medical Leave of Absence

For more information on Medical Leave of Absence and reinstatement for undergraduate and graduate students at KSAS and Whiting, please visit the Office of the Dean of Student Life’s Medical Leave of Absence page. All other students and learners should contact their program’s student affairs office or program director for information on leave policies.