Consent For Information Sharing - Department Of Education printable pdf download

Consent For Information Sharing - Department Of Education

Model for the Coordination of Services to Children/Youth

Information for Parents/Guardians – Guidelines for Discussion

Informed Consent

Children/youth and families may receive services from many agencies and service providers to

meet their needs. To ensure that your child’s needs are met, service providers will work

together with you to develop an Individual Support Services Plan (ISSP). In order to develop

an effective support services plan, information about your child will be shared. You will be

asked to sign a consent form to permit information sharing. This will allow the support services

team to discuss strengths and needs, coordinate service delivery and monitor services to ensure

that your child’s needs are met.

Before you sign this form you should know:

• You and your child/youth have a right to take part in the ISSP process.

• You have the right to privacy.

• If you consent to the sharing of information, your consent must be informed (the person

asking you to sign the form will explain the purpose of sharing information).

• You have the right to know what information is to be shared and how the information is

to be used.

• You can decide what information will be shared with whom, for what purpose, and to

what benefit.

• Only relevant information about your child’s strengths and needs will be shared for the

purpose of developing the ISSP.

• You have a right to refuse consent.

• Information will not be shared without your consent, unless the life, health or safety of

your child or others is at risk.

• You have the right to ask questions before you give consent.

• You will decide how long the consent may be used (not to exceed one year).

• If you sign this consent form, and give permission to complete a child/youth profile,

information about your child’s/youth’s needs will be entered into a data base to be used

for regional and provincial service planning and for the development of

regional/provincial reports. Personal data will be kept confidential. Information will be

shared with service providers only on a need-to-know basis to assist with meeting the

needs of your child.

• You are entitled to receive a copy of all completed forms, including your child’s profile.

January 2002

Consent For Information Sharing - Department Of Education