Client Notice of Rights/Confidentiality Form for Advocacy Organizations
As a rider of Sisters of the Underground, you have the following rights regarding the confidentiality of your personal information and communications with Sisters of the Underground staff and volunteers:
1. The information that you provide to Sisters of the Underground will be kept confidential to the greatest extent allowed by law.
2. You may choose what information you want to provide to Sisters of the Underground. You will not be denied access to services if you choose to not provide certain identifying information.
3.The information that you provide to Sisters of the Underground, including your name, address, phone number, and other personal information will not be shared with other individuals or agencies without your permission.
4. Sisters of the Underground staff may be required by law to report certain situations even if you don't give them permission to share or report the situations, such as suspected child abuse or neglect. Staff and advocates will inform you of any reporting requirements prior to having conversations with you and will tell you when they must make a report and what information will be shared. Even when these reports are made, Sisters of the Underground should not share information beyond what is required by law.
5. Some general information about the types of services provided and overall demographics (e.g., age and income ranges, average number of children, ethnicities) of people that use Sisters of the Underground services must be shared with the agencies that fund Sisters of the Underground. However, information that specifically could identify you as someone who used Sisters of the Underground services will never be shared unless specifically authorized in writing by you.
6.After your intake with Sisters of the Underground, you may choose to be referred to other agencies for additional help and support. Agencies we partner with.
7. You can decide how much or how little of your personal information Sisters of the Underground will or will not be shared with each partner agency. You will be told, in general, what each partner's obligations are to keep your information confidential. If you choose to have Sisters of the Underground share some of your personal information with an agency we partner with, you will be told exactly how and what information will be shared. If you later decide that you do not want the information you have provided to be shared with any of Sisters of the Underground partners, let us know and we won't share any more information with those partners.
8. If you have any questions or concerns about this notice or your rights, or if you have a concern that your confidential information was not treated appropriately, please contact Lesedi Shakur 725-243-6168.