Kentucky River Foothills Development Council, Inc. Agreement to Assure Confidentiality of Clients

I understand that all information regarding the consumers, former consumers, or persons having received services from Kentucky River Foothills Development Council, Inc. (KRFDC) must be kept confidential under the provisions of KRS 210.235. I understand that the information, which I receive, may only be utilized for programmatic purposes within KRFDC to carry out the proscribed services for that consumer unless the consumer or legal guardian shall acknowledge consent to release the information. I am aware that violation of the requirement of confidentiality is punishable by a fine up to five thousand dollars or imprisonment for a term not to exceed five years, pursuant to KRS 210.991.

By my signature below, I herby agree to assure the confidentiality of information I receive from others or obtain from my own observations regarding consumers, former consumers, or persons who have sought services at KRFDC.

 


Signature & Date


Witness & Date

 

 

 

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