Exhibit 2-7

Protecting the Privacy of Student Records Exhibit 2-7 Examples of Forms Pertaining to Releasing Confidential Information That Informs Patients of Their Rights under 42 CFR

CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS

The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by Federal law and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser unless:

(1) The patient consents in writing; OR
(2) The disclosure is allowed by a court order; OR
(3) The disclosure is made to medical personnel in a medical emergency or to a qualified personnel for research, audit, or program evaluation; OR
(4) The patient commits or threatens to commit a crime either at the program or against any person who works for the program.

Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.

Federal law and regulations do not protect any information about suspect child abuse or neglect from being reported under state law to appropriate state or local authorities.

(See 42 U.S.C. Sec. 290dd-2 for Federal law and 42 CFR Part 2 for Federal regulations.)

Legal Action Center. (1996) Handbook on legal issues for school-based programs (Revised). pp. 71, 72, & 74. New York: Author.

PROHIBITION ON REDISCLOSURE OF INFORMATION CONCERNING CLIENT IN ALCOHOL OR DRUG ABUSE TREATMENT

This notice accompanies a disclosure of information concerning a client in alcohol/drug abuse treatment, made to you with the consent of such client. This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

I, ___________________________________ authorize (Name of patient)

________________________________________________ to
(Name of general designation of program making disclosure)

disclose to

____________________________________________________
(Name of person or organization to which disclosure is to be made)

following information: ______________________________________
(Nature of the information, as limited as possible)
_______________________________________________________
_______________________________________________________ The purpose of the disclosure authorized herein is to: ______________
_______________________________________________________ (Purpose of disclosure, as specific as possible) ______________________________________________________________

I understand that my records are protected under federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time except to the extent that action has been taken in reliance on it, and that in any event this consent expires automatically as follows:
_______________________________________________________ (Specification of the date, event, or condition upon which this consent expires)

Dated: ___________

_____________________________
Signature of participant

_____________________________
Signature of parent, guardian or
authorized representative when
required

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