Santa Barbara County Coordinated Entry System Confidentiality Agreement
As part of your participation in the Santa Barbara County case conferencing process (hereinafter referred to as “Case Conferencing”), you may have access to view, update
or modify sensitive information about clients that have been surveyed through the Coordinated
Entry System (CES). During the Case Conferencing meetings, clients’ clinical
and legal information is shared for purposes of assessment and placement. All Case Conferencing process participants must maintain the confidentiality of all sensitive client information.
Sensitive information includes but is not limited to:
• Client names, nicknames or any other identifying information
• Client address, location or whereabouts
• Client personal finance information including social security numbers, financial data or
• Client health information including information on medical conditions, treatment or
• Any other identifying client information discussed during the case conferencing process
Any information collected, accessed, or viewed, whether it is verbal, written, electronic, printed
or any other form, as part of the Case Conferencing process is to be treated
as confidential and must not be disclosed. Sensitive information will not be shared with
prosecutors, the police, debt collectors, or a private landlord seeking eviction, unless that party
has a lawful warrant or similar order from a Court. In the event you are unsure if information
can be shared, DO NOT DISCLOSE INFORMATION.
As a participant in the Case Conferencing process I understand that I will have
access to sensitive information. I agree that information obtained during the case conferencing process is NOT to be released to anyone who is not a Case Conferencing participant. By signing this document, I attest to the fact that I have read and comply with the terms of the Santa Barbara County Memorandum of Understanding (MOU) between HMIS Lead Agency and HMIS Partner Agency and the Omnibus Consent Form for Release of Information HMIS Santa Maria/Santa Barbara Continuum of Care.
Unauthorized disclosure of sensitive information received through Case Conferencing may be a
violation of State and Federal Privacy Laws and punishable by law as a criminal violation and may result in disciplinary action, legal action and may result in dismissal from participation in the Case Conferencing process.
Sign in to Google
to save your progress.
Signature (By my signature below, I acknowledge that I have read and agree to the above stated terms of my participation in the Case Conferencing process.)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service