Confidentiality Statement Form {CRM-223}

CONFIDENTIALITY STATEMENT FORM SAN DIEGO SUPERIOR COURT Adult Drug Court Program I, _______________________, as a participating member or guest of the __________ Drug Court, duly recognize my responsibility to the confidentiality of the Drug Court Program, and hereby agree: 1. Any information discussed at a team meeting shall remain confidential and will not be revealed to anyone. Names of program participants will be disseminated to team members* only. Any information gathered during a 4th waiver search will be shared with team members* only unless it relates to evidence of a new crime. Photos, Drug Court files and addresses of Drug Court participants will remain confidential, to be used by Drug Court Team members* only. Warrants of arrest are not confidential. Information in ARJIS system is not confidential. 2. 3. 4. 5. 6. Signed: _______________________________ Date: _________________ Note: This form is necessary in order to comply with Title 42 of the code of Federal Regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records. * Team members include law enforcement liaison officers and all team back-up members. SDSC CRM-223(New 1-06) American LegalNet, Inc. www.USCourtForms.com