Kindness Between Friends, has been established as a means of peer support to serve members of our community. Our advocates are volunteers and receive no compensation for services but are simply concerned citizens willing to do what they can to help fellow citizens with needs.

Our Outreach program is a process that involces an assessment of needs, establishment of goals and the development of a plan to accomplish these goals. Our purpose is to connect clients with services and provide support and coordination access to services. The services may include, but are not limited to, mediccal and mental health referrals, nutritional aid, access to affordable housing, employment, etc. Our services Do Not provide cash assistance, direct payment for housing.

Client participation in our program is voluntary but once commitment has been made, there will be an expectation that the client is interested in  reaching yoals and is willing to be proactive in following a plan. We expect you to honor your commitments with your advocate and any people/services brought in to support you and your goals. If you miss appointments or do not do your part of achieving your goals, you will be placed on a 30 day suspension. At that point, the Advocate will reevaluate your case to decide if it should continue or closed.

By signing below, I acknowledge that these terms have been explained to me and I understand that my continued eligibility for the program requires my continued effort and participation.

Additionally, to respect the privacy and support the dignity of the people we serve, (hereafter referred to as 'clients') our outreach program finds it imperative that our Director, Members, and Volunteers do not discuss or disclose personal information about our clients publicly or any form outside of our 'scope of services.' Within the organization, it will, at times be necessary to share certain information with third-party service providers in order to obtain services and cooperate with these providers in a manner that best serves our clients. 

We take seriously our responsibility to use the highest level of discretion in discerning which information is imperative when pursuing outside services.

By signing below, I acknowledge that these terms have been explained to me and I fully understand that certain information that I provide will have to be shared to obtain services.

By signing below I fully agree to the terms above. 

I AUTHORIZE THE USE/DISCLOSURE OF HEALTH AND/OR OTHER IDENTIFYING INFORMATION ABOUT ME AS DESCRIBED BELOW: 

Person(s) or Organization(s) authorized to provide the information:
Any related to my case

 Person(s) or Organization(s) authorized to receive the information:
Kindness Between Friends, Inc

 Specific description of the information that be may be used or disclosed (including date(s)):
Anything related to my case

 Specific description of how the information will be used:
To help me obtain services

 

I understand this authorization will expire one year from today or when my case is closed, whichever comes first, but will not last more than one year. 

I understand that I may revoke this authorization (except to the extent that the action was already taken in reliance to the signed authorization) at any time by notifying Kindness Between Friends in writing.

I understand that I can refuse to sign this authorization and it shall not impact my ability to receive programs or services or otherwise interact with Kindness Between Friends, however not all services may be available to me. 

I may inspect or copy any information used or disclosed under this agreement.

I understand that if the person or organization that receives the information is not a healthcare provider or plan covered by federal privacy regulations, the information described above may be re-disclosed and would no longer be protected by these guidelines.