To be Read and Signed by Agency Staff, Clients, And Volunteers

Access to Confidential Records

In order for Covenant to Care for Children, Inc. to provide a responsible and professional service to clients, it is necessary for volunteers, clients and parents or guardians of clients to be asked to divulge extensive personal information about themselves and their families. The agency respects the confidentiality of client and volunteer records and, with the exception of situations listed below, shares information about the clients and volunteers only among the appropriate agency staff. The right to confidentiality applies not only to written records and conversations, but also to videos, film, pictures or use of clients’ or volunteer’s names in agency publications.

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves. In order to provide a service which is in the best interest of the children served by program, information from outside sources, including confidential references must be assessed along with information gained from the clients or volunteers themselves. Records are not available for review by the clients or volunteers. Clients and volunteers shall be provided at the time of application and staff at the time of hire, with a copy of this statement on confidentiality along with the exceptions which define the limits of the confidentiality. Staff, clients and volunteers shall sign a statement that he/she has read and understands the agency policy on confidentiality and agrees to follow the guidelines it sets forth.

Limits of Confidentiality

1. Information will be released to other individuals or organizations only upon presentation of an authorized “Authorization for release of confidential information” form appropriately signed by the client or volunteer.
2. Identifying information regarding clients and volunteers may be used in agency publications or promotional material if the client or volunteer has given permission.
3. For purposes of program evaluation, audit, or accreditation, and with prior approval of the Board of Directors, certain outside bodies such as CT Mentoring Project, may have access to client and volunteer records. These outside organizations shall be required to respect the agency policy on confidentiality. Outside parties shall be required to use information only for the purpose stated in the approval action of the Board of Directors. Known violators and appropriate disciplinary action shall be requested.
4. A violation of the agency’s confidentiality policy by a staff member will be subject to disciplinary actions up to and including dismissal.
   1477 Park Street
   Suite 2A
   Hartford, CT 06106
   Telephone (860) 243-1806
   Fax (860) 243-0100
   www.covenanttocare.org
5. Members of the Board of Directors have access to client files only upon the authorization by formal motion of the Board of Directors. The motion shall state who shall be authorized to review records, the specific purpose for such review and the period of time during which access shall be granted.
6. Members shall be required to comply with the agency policies on confidentiality and may use the information only for the purpose stated by the approved action of the Board of Directors. Known violations shall be reported to the Board President. A violation of the agency’s confidentiality policy by a Board member shall constitute adequate cause for removal from office.
7. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.
8. Information shall only be provided to an agency’s legal counsel in the event of litigation or potential litigation involving the agency. Such information is considered privileged information, and its confidentiality is protected by law.
9. State law mandates that suspected child abuse be reported to the Department of Children and Families or the police. All workers are responsible for staying abreast of such reporting requirements of their respective jurisdiction and shall always comply with mandated procedures.
10. If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or 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 law enforcement authorities.

I have read and understand the above document which states the agency policy with respect to confidentiality of client and volunteer records. I agree to the program and/or agency participation under the conditions it sets forth.