Confidentiality in the Student Development Centre
The Student Development Centre keeps your personal information strictly confidential. While personal information is shared among our Professional staff as needed to provide you with service, with few exceptions (see below) your personal information is not released to any office or individual outside of this group without your written consent.
The Student Development Centre may disclose your personal information as necessary to comply with legal or professional obligations. For example:
1. All staff are legally required to report any reasonable suspicion of abuse of a child UNDER THE AGE OF 18 that is currently occurring or may occur.
2. In rare situations involving court actions, staff and/or their records can be subpoenaed.
3. When a staff member has reason to believe that a student will carry out threats of violence against a specific person, including yourself, or group of persons, the staff member has a duty to report the details of the threat to the responsible authorities, including University authorities, with the power to address the threat. Whether a student is likely to carry out threats is a matter for the staff member to decide in his or her judgement but, generally, to warrant disclosure there must be a clear risk to an identifiable person or group of persons, there must be a risk of serious bodily harm or death and the danger must be imminent.
It is important that administrators working outside the Student Development Centre who are responsible for students-at-risk can identify students-at-risk, provide them with effective support and assess risks to members of the Brock community.
Accordingly, based on your consent, the Student Development Centre may disclose information to members of a Student-at-Risk Case Team constituted under the Code of Student Conduct and Disciplinary Procedure in Non-Academic Matters Policy if, in the opinion of the Director of the Student Development Centre (or her/his delegate), your mental state is such that you may be a threat to yourself, others or the Brock community in general. This disclosure is made so the Case Team can provide effective support and assess risk and is limited to the following information:
1. the fact that you are receiving professional care from the Student Development Centre,
2. the name of the Student Development Centre professional or professionals providing care; and,
3. other information reasonably necessary to help the Case Team provide effective support and assess risks.
Please note that the Case Team may only use and disclose information received from the Student Development Centre for the purpose of providing effective support to students-at-risk and assessing risks. It is also required to keep this information reasonably secure from unauthorized loss, use or disclosure.
If you do not consent by signing this form, you may still receive treatment and support from the Student Development Centre.
PLEASE DO NOT SIGN THIS FORM UNTIL YOU HAVE MET WITH A STAFF MEMBER AND DISCUSSED ANY CONCERNS YOU MAY HAVE ABOUT THIS POLICY.
[ ] I have read and understand the confidentiality policy.
[ ] I consent to the collection, use and disclosure of my personal health information as described above.
Staff Signature: ________________________