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Statement of Understanding

Fees:

Services provided by Wayne Corporation are offered at no direct cost to clients. The employee’s company has already paid for this service. If assistance beyond the scope of services provided by Wayne Corporation is needed, the EAP counselor will help locate appropriate community agencies. It is the clients’ responsibility to assume costs from such referrals.

Feedback/Release of Information:

Information concerning the use of Wayne Corporation will not be made part of the client’s personnel record and will not be disclosed except as described below:

Self-referrals – If any employee or family member voluntarily comes in for assistance, no information concerning person’s counseling with Wayne Corporation will be discussed without the individual’s written permission.

Supervisor referrals – If an employee is referred by his/her supervisor because of a work performance problem; Wayne Corporation will only confirm EAP participation.

Confidentiality:

With the exception of Supervisor Referrals, Wayne Corporation will keep all information gained through the counselor/client relationship strictly confidential, except as required by law or in situations deemed potentially life threatening.

Federal regulations do not protect from disclosure of information to a client’s commission of a crime against Wayne Corporation property or personnel or reports under state law of suspected child abuse or neglect. (See U.S.C. 290dd-3 and 290ee-3 for federal laws and 42 CFR Part 2 for federal regulations.)

Participation in the services offered by Wayne Corporation is voluntary. Wayne Corporation staff may follow-up with you by phone or letter to evaluate our effectiveness and your satisfaction. If you do not show up for your appointment, your case will be administratively closed after 3 weeks have passed from the date of the missed appointment.

Additional questions or comments can be directed to Wayne Corporation counselor or staff person at 502-451-8262.