Your safety and privacy are important to us. You decide the information you want to share and with which Partner agencies listed on this form. Partner agencies of PorchLight, A Family Justice Center (“PorchLight”) follow different rules about keeping information private. Each Partner agency you decide to meet with will talk to you about any limits to their confidentiality.
Purpose of Release of Information
This authorization is made so that PorchLight and its Partner agencies can more effectively coordinate services received by me and/or my children. I also understand that PorchLight is required to provide general, non-identifiable information about individuals that receive services at PorchLight to certain public and non-public funding sources.
I acknowledge that I will not be denied services if I choose not to release information to Partner agencies.
Exceptions to Confidentiality
Some of our Partner agencies are mandated reporters and are required to comply with laws regarding mandatory reporting of suspected abuse and/or neglect of children, elders, or at-risk individuals. PorchLight and Partner agencies may also be required by law to report situations that pose an immediate danger to you or others.
SELECT AGENCIES ON NEXT PAGE.
