UNDERSTANDING CLIENT PRIVACY RIGHTS & RESPONSIBILITIES

MY FRIEND’S HOUSE WILL ENSURE THAT:

•  The information we have gathered about you is as accurate as possible
•  You understand what, when, where and why others may see your information
•  You have the opportunity to make more informed decisions when you consent to share
your information with others

WE WILL COLLECT THE FOLLOWING INFORMATION ABOUT YOU:

• The reason that you requested our services
• Your name, address, phone number, birth date
• Family and community supports
• Family and personal history (if relevant)
• Medical history, medications and allergies (if relevant)

My Friend’s House will maintain the confidentiality and security of your personal
information with the exception of the circumstances outlined in “How Your Information
May Be Shared with Others”.

YOUR INFORMATION WILL HELP US TO:

• Contact you, if necessary
• Identify and plan the services you need
• Communicate effectively with other professionals involved in your care
• Evaluate and improve all of our programs and services

YOUR PRIVACY RIGHTS:

You have the right to:
• Request a copy of all or parts of your file
• Request a correction to your information
• Not share your personal information

YOUR PRIVACY RESPONSIBILITIES

• Please respect the privacy and confidentiality of other people that you may see or meet
here at My Friend’s House

HOW YOUR INFORMATION MAY BE SHARED WITH OTHERS

With your written or verbal permission:
• We will forward the appropriate information to the person requesting the information.
• Whenever possible, you will be given the opportunity to review any written information
before it is sent.

Without your permission:
We will share information about you or your family:

• With other MFH staff members involved in the services you are receiving
• If there is any indication that a child is being, or is at risk of being, physically or emotionally abused or neglected
• If it is necessary to reduce a significant risk of serious bodily harm to you or someone else
• As permitted or required by law

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