1. Information will be released to other individual or organizations only upon presentations of an authorized “Consent to Release Information” form appropriately signed by (i) the client’s parent/guardian when the information requested relates to the client, or (ii) by the volunteer when the information requested relates to the volunteer.
2. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside organizations such as Big Brothers Big Sisters of America may have access to client and volunteer records. These outside organizations shall be required to respect the Agency’s Confidentiality Policy. Outside organizations shall use such information only for the purpose(s) approved by the Board of Directors. Known violations of Agency’s Confidentiality Policy will be reported to the supervisor of the individual involved, or to the CEO, and appropriate disciplinary action shall be taken.
3. Members of the Board of Directors have access to client files for various reasons, including (i) program evaluation, audit and case planning, (ii) in circumstances adversely impacting the Agency to evaluate the impact and the Agency’s response, and (iii) at the discretion of the Executive Committee of the Board of Directors and/or at the discretion of the Agency’s Management Team.
4. Information shall be provided to (i) Agency legal counsel or any counsel selected by the Agency and/or (ii) the Agency’s insurance carrier, in the event of litigation or potential litigation or at the discretion of the Chief Executive Officer or the Executive Committee of the Board of Directors for any matter involving the Agency. Such information provided to legal counsel is privileged information, and law protects its confidentiality.
5. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.
6. At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties. The information about the volunteer may include such items as: age, sex, race, religion, interests, hobbies, marriage/family status, sexual orientation, living situation, etc. Information about the child may include such items such as: age, sex, race, religion, interests, hobbies, family situation, etc.
7. State law mandates that suspected child abuse be reported to the Florida Department of Children & Families. Agency workers shall comply with mandated procedures.
8. If an Agency worker receives information indicating that a client or volunteer may be dangerous to himself/herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or a report to the local law enforcement authorities.
I have read and understand the above document which states the agency policy with respect to confidentiality of clients and volunteer records. I agree to program participation under the conditions it sets forth.