Consentimiento y autorización para comun

Consent and authorization for communication of clinical information

This form allows for the electronic authorization of the communication of clinical information between the psychologist and the parents of the minor, in accordance with current data protection regulations and the Psychologist's Code of Ethics.

Name of the minor:

Date of birth

Day

Month

Year

Name of parent/guardian:

ID/NIE:

Relationship with the minor:

E-mail:

The psychologist responsible for data processing is Carmen Sánchez Iglesias , member number M-40781.

The purpose of this consent is to authorize the communication of clinical information relating to the therapeutic process of the minor identified in this form with his or her parents or legal guardians.

The data processed is health data, which is considered specially protected.

The information that may be communicated will be strictly limited to what is necessary and will never involve the complete transfer of the content of the sessions.

This consent is based on Regulation (EU) 2016/679 (GDPR) and Organic Law 3/2018 (LOPDGDD).

You can withdraw this consent at any time as easily as you give it, by contacting the psychologist or through the link provided for this purpose.

You have the right to access, rectify, delete and limit the processing of your data, as well as to file a complaint with the Spanish Data Protection Agency.

If the patient is 16 years of age or older, they give their own legally binding consent. If they are under 16 years of age, consent is given by their parents or legal guardians, and the minor gives their assent.

Specific authorization to share information:

(Check as appropriate)

Opciones múltiples

General information on therapeutic evolution

Guidelines and recommendations for the family environment

Psychological reports or clinical feedback

Other (please specify)

Respuesta corta

Consent to share information with other professionals when clinically relevant and necessary for the care of the case:

I authorize the psychologist to share the above authorized clinical information with other health or education professionals (e.g., psychiatrists, educators, family therapists, or other members of the therapeutic team) strictly when necessary for the continuity, evaluation, or coordination of treatment , and always subject to the legal duty of confidentiality and respect for professional secrecy.

I have read the above information and, as the parent/legal guardian, I consent to the psychologist sharing the indicated clinical information about the minor with his/her parents.

Minor's consent (recommended):

I have spoken with the psychologist and I understand that some things from my sessions may be explained to my parents and other professionals when it is useful for my treatment.