INFORMED CONSENT 知情同意书

Personal Data Protection Act 个人资料保障法令 (PDPA)

To comply with PDPA, City Harvest Community Services Association (CHCSA) has implemented the Personal Data Protection Policy on the collection, use, disclosure, access, update and correction, as well as care of personal data of clients.

为了遵守PDPA，城市丰收关怀服务社（CHCSA）实施个人资料保障政策，以收取、使用、披露、存取、更新、改正、以及照顾当事人的个人资料。

Personal Disclosure 披露个人资料声明书

In the process of seeking help, I take personal responsibility to disclose necessary information to the best of my knowledge. I allow the caseworker/social worker whom I work with, to verify the given information with any relevant organizations as deemed fit by their professional assessment.

在寻求帮助的过程，我了解我本人有责任尽可能透露一些必要的资讯。我允许与我合作的个案工作者／社工，根据他们专业的评估，向相关单位证实我所透露的资料。

Confidentiality 保密性

I understand that all casework & counselling-related communication and records are kept confidential, with the following exceptions:

  • a. When the caseworker/social worker makes an assessment of a foreseeable suicide risk;

  • b. When the client acknowledges ongoing instances of incest, rape, abuse of a child, elderly, or disabled person;

  • c. When the client reveals his/her intention to commit a crime or when he/she can be accurately assessed as being a danger to self, others or society;

  • d. When counselling information is ordered by a court and/or government body/agency.

I acknowledge that in the situations mentioned above, my caseworker/social worker may need to disclose information to the appropriate authorities, as outlined in the confidentiality agreement.

我明白所有和个案工作和辅导有关的沟通与记录都受到严格的保密，唯以下几种情况除外：

  1. a. 当个案工作者／社工判断当事人有自杀的危险；

  2. b. 当当事人透露当时正发生强奸，乱伦，或儿童，老年人，残障人士遭受虐待的事件；

  3. c. 当当事人透露他／她有犯罪的意念，或者社工能准确判断当事人足以对自己、他人、或社会造成伤害；

  4. d. 当法庭和／或政府机构／组织必须索取与辅导相关的资料。

我已阅读并明白以上所列明有关无法受到完全保密的特殊情况。我明白在这些情况下，个案工作者／社工有道德义务及法律责任告知有关当局。


I give consent to the following 我同意以下的条件 

1. Personal Data Protection Act 个人资料保护法令

I understand that with effect from 2 July 2014, the Personal Data Protection Act (PDPA) is introduced to protect individuals’ privacy against misuse. As such, I agree to allow CHCSA to collect, use and/or disclose my personal data to 3rd parties for the purpose of providing services such as but not limited to the following:

  • a. Liaison and referrals to other social service agencies

  1. b. Home visits by volunteers in the area of befriending, groceries delivery etc.

  2. c. Disbursement of assistance

Without my given consent, CHCSA would not be able to proceed with further assessment and provision of services to me. 

我明白从2014年7月2日开始，新加坡将介绍《个人资料保护法令》（PDPA）保护个人的隐私不遭滥用。因此我同意允许CHCSA收取、使用和／或向第三方披露我的个人资料，作为（但不限于）以下的服务目的：

  1. a. 联络并转介至其他社会服务机构

  2. b. 志工进行家访，以彼此认识、提供日常用品等

  3. c. 提供资助

若未获得同意，CHCSA将无法向我提供进一步的协助或服务。

2. Clinical Supervision 专业督导

I am aware that all caseworkers/social workers in CHCSA undergo clinical supervision as part of their professional development.  Supervision may involve audio/videotaping of counselling sessions and direct observation by supervisors and co-workers. I understand that supervision allows for instruction and/or supervisory input, ensuring me the highest service quality possible and I give my permission for such supervisory procedures. I also understand that all the audio/videotapes are kept in locked cabinets and they are strictly for training purposes only.  All tapes are routinely erased not more than six months from the time of taping.

我知道CHCSA的所有个案工作者／社工都接受专业督导以作为辅导员专业培训的一部分。专业督导包括影音录制辅导的过程，以及上司或同事现场观察辅导的进行。我了解专业督导是为了给予他们指导及／或专业意见，以确保他们提供给我高素质服务。我在此允许这些督导程序的进行。我也了解所有的影音录制都存放在上锁的厨里，并单单用于培训。所有录音带或录像带将在录制以后的六个月内被删除。

3. Research  研究

I understand and agree to participate in CHCSA-approved counselling evaluation and/or counselling-related research. I understand that the personal data which I provide to CHCSA (including data which is in an individually identifiable form) may be used for such research and I consent to such use of my personal data.   

我明白且同意参与CHCSA所批准的辅导评诂和／或相关的研究。我明白我提供给CHCSA的资料（包括具个人识别性的资料）可用于相关研究，我也同意使用我的个人资料作为此用途。