NOTICY OF PRIVACY ACT RIGHTS
Pursuant to the Privacy Act 10 U.S.C. 8013, all personal information provided to The Dock Ellis Foundation, inc by way of any Board Member or Caregiver Case Manager shall be held in confidence at all times and only shared with outside agencies and organizations that serve to assist the Client.
This agreement signed by the Client shall serve as his or her authorization to share protected information with other agencies and organizations, only for the direct purpose of assisting the Client in his or her case through The Dock Ellis Foundation, inc
Required by Law. DEF Caregiver Case Managers will disclose protected information when required by law in any; but not limited to, of the following situations:
• Reporting child abuse or neglect
• Court ordered
• Legal duty to warn or take action regarding imminent danger to others
• When client is a danger to self or others, or gravely disabled
• When required to report certain injuries
Fundraising. DEF may contact clients as part of its fundraising activities.
Emergencies. In life threatening emergencies, DEF staff will disclose protected information
necessary to avoid serious harm or death.
Client Authorization or Release of Information. not use or disclose your protected information in any way without a signed authorization or release of information from you, except for the use in obtaining outside services; including but not limited to, mental health counseling, legal assistance, temporary housing and/or emergency shelter assistance. The authorization or release may be revoked by written request only. The revocation will apply upon receipt of notice in writing.
Copy of this Notice. You have a right to obtain another copy of this Notice upon written request.