Please read this document in its entirety.
As a potential participant of Big Brothers Big Sisters of Greater
Chattanooga (BBBSGC), I understand that I have access to confidential
information about volunteers and/or clients and families. I fully understand
and accept the responsibilities inherent in my role to maintain the complete
confidentiality of all personal information, documents and parties who are
engaged in this partnership (collectively, the “Confidential Information”),
including myself, BBBSGC and all its affiliates and employees, public figures
as well as all children and families that are served by this partnership. The
obligation of confidentiality persists indefinitely and it not limited to the
period of time beginning with my participation in BBBS and ending at the close
of my participation.
In order for BBBSGC to provide responsible and professional
services, it is necessary for volunteers, clients and parent/guardians of
clients to disclose personal information. BBBSGC respects the confidentiality
of client/volunteer information. Confidentiality applies to written records,
electronic records, voice, verbal statements, pictures (motion or still) and
the use of client/volunteer’s name in agency publications. All records are
considered property of the agency, not of agency staff, partner agencies,
clients, parent/guardians or volunteers.
I further agree to the following terms:
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In the
event that an actual breach of confidentiality or a release of Confidential
Information has occurred or if a situation which I reasonably believe may
result in a breach of confidentiality comes to my attention, I agree to
immediately notify the designed BBBSGC representative and/or any other
appropriate BBBSGC staff members. I understand and agree that I am required to
report such breach or threatened breach of confidentiality regardless of
whether the breach is caused by my own actions or by the actions of another
person.
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According
to the Confidentiality Policy, information from client/volunteer records may
only be shared with individuals/organizations as specified:
o Identifying information regarding a client/volunteer
may be used in agency publications or promotional material only if the
client/volunteer has given written permission.
o Information shall be provided to law
enforcement or courts only with a valid, enforceable subpoena.
o Information shall be provided to BBBSGC legal
counsel in the event of litigation or potential litigation involving the
agency.
o State law requires that suspected or disclosed
child abuse, exploitation or neglect be reported.
o If agency staff receives information that
indicates that a client/volunteer may be dangerous to himself/herself or to
others, steps shall be taken to protect the appropriate party, including a
report to the law enforcement authorities.
o When a child/volunteer is considered for a
match, information is shared between the prospective parties. The identify of
the parties is not revealed until after the parties agree to the match. Each
party has the right to refuse the proposed match based on the anonymous
information provided. Information shared may include: age, sex, race, religion,
education, interests, hobbies, marriage and family status, living situation,
sexual orientation, reasons for applying to the program, expectations for match
participation, a summary of the reasons an individual was chosen for the match,
and all other information deemed relevant. The individuals to whom the
information is provided shall agree not to share the information with any other
person.
o Certain outside bodies, including members of
the Board of Directors, may have access to client volunteer records for the
purposes of program evaluation, audit, accreditation, and/or for purposes of
operating and making available approved software, on-line sites and login
portals. All such authorized persons and representatives shall enter into a
Confidentiality Agreement before receipt of any information from
client/volunteer records.
o Personally identifiable information of
students which is obtained from education records provided by any school
district or school will only be used or re-disclosed by BBBSGC or its
authorized representatives. Such information may not be re-disclosed to any
third party (except back to the school district or school) without prior written
consent of the school district or school, the parent or eligible student. Such
information may not be used for any purpose other than the purpose stated in
the agreement with the school district or school pursuant to which the
information was obtained, and will only be disclosed to those authorized
representatives of BBBSGC who have a legitimate interest in the program
pursuant to which the information is provided.
Other that in the instances set forth above, information from
client/volunteer records shall not be released unless accompanies by an
authorized consent to release information form signed by the client/volunteer. If
the client is under the age of 18, the consent to release information form must
be signed by the child’s parent/guardian.
Thank you for your careful consideration and willingness to
uphold the privacy and confidentiality of those participating in Big Brothers
Big Sisters.