- Upon employment and whenever revisions are made to the Lois’ Lodge Confidentiality Policy, all staff and volunteers are required to sign a compliance statement which indicates an understanding of the requirements of confidentiality.
- Lois’ Lodge will maintain a confidential care record for each resident; a confidential personnel record for each employee; and confidential records for all volunteers.
- All confidential files will, under the control of the Executive Director, be maintained in a secure, locked file cabinet.
- Access to confidential files will be limited to persons authorized pursuant to law. Those persons shall include the resident; the birth parent or legal custodian when the resident is a minor; agency staff; auditing, licensing or accrediting personnel; and those persons whom the agency has obtained a signed consent for the release of confidential information.
- Lois’ Lodge will permit a resident to review their case file in the presence of agency personnel on the agency premises, in a manner that protects the confidentiality of other family members or other individuals referenced in the record, unless agency personnel determines the information in the resident’s record would be harmful to the resident.
- In cases of perceived harm to the resident, staff will document in writing any refusals to share information with the resident; or birth parents or legal custodians of a minor resident.
- Lois’ Lodge will require that a consent for release form is signed when client information is disclosed.
- Staff and volunteers will not discuss a resident’s situation while in the presence or hearing of any other residents or third parties.
- Alleged breaches of confidentiality are to be reported to the Executive Director through the Incident Report Form which can be accessed through the Volunteer Coordinator, the Program Coordinator or the Executive Director.
- Alleged breaches of confidentiality will be investigated by the Executive Director and may result in termination or employment/service.
- Confidential files/records and or information regarding employees, volunteers, and contributors will be treated with the same respect and confidentiality as client records.
- Records may be shredded/destroyed by authorized personnel three years after a resident has been discharged, or three years after a resident reaches the age of 18, unless included in a federal fiscal or program audit that is unresolved, then the agency may destroy the record in office when released from the audits.
- Lois’ Lodge will inform all individuals with access to confidential information of the provisions of this confidentiality policy.
When you have completed reading the confidentiality policy please check the confidentiality box to sign off and express understanding of this document.