HMSA Online Intake Form
For immediate response or in the moment support, please call us directly:
Students (SAP) 1-888-387-1540 or Employees (EAP) 1-800-847-7240.
If this is an emergency, please call 911.
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Company/Institution Name
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Last Name
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STATEMENT OF UNDERSTANDING
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Health Management Systems of America (HMSA) administers both Employee Assistance Programs (EAP) and Student Assistance Programs (SAP) that provide assessment, referral, and short-term problem resolution for a wide range of personal, school and job-related concerns. There is no cost to you for HMSA’s services and the information obtained by HMSA is held in the strictest of confidence.
CONFIDENTIALITY
HMSA originates and maintains paper and/or electronic records containing information designated as Protected Health Information by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This information will serve as:
A source of information for assessing the scope of your problem and determining the appropriate level of care required to assist you.
A means of communication among the many healthcare professionals who will contribute to that care.
A tool for routine healthcare operations such as assessing quality and reviewing the competency of the healthcare professionals contributing to your care. Neither the EAP/SAP counselor, nor HMSA, will reveal any of the information that you disclose to anyone outside the Employee/Student Assistance Program except when you consent in writing or the law requires disclosure. Generally, the law does not require information to be released unless life or safety is seriously threatened.
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