Confidentiality Agreement for Case Conference Participants

Confidentiality Agreement for Case Conference Participants

The Fulton County KIDS Project (1994b) in Hickman, Kentucky, developed the following confidentiality agreement for members of the case conference team:

"Confidentiality Agreement for Case Conference Participants

I, as a participating member of this case conference team, understand and agree that confidentiality of identifiable information shall be maintained according to Part V, Privacy Act of 1974, and the Kentucky Revised Statutes on Confidentiality (KRS 194.060, KRS 200.490, KRS 210.235, KRS 210.670, and KRS 22.270).

I understand and agree that the oral information presented at this case conference will not be released to other nonparticipating agencies/persons without the express written consent of the parent or guardian.

Name of Child/Youth/Family____________________________

Date of Conference___________________

Signature___________________________ Agency________________________

Signature___________________________ Agency________________________"

References