This Consent is given by the Resident in favour of Roots to Recovery (hereinafter referred to as "the Facility") in respect of the collection, use, storage, sharing and disclosure of personal information, and in respect of communication with nominated parties, for the duration of his stay at the Facility.
RESIDENT PARTICULARS
RESPONSIBLE PERSON
Purpose of this Consent
The Facility is committed to processing personal information lawfully, fairly and in a manner that respects the dignity and privacy of the Resident.
The Resident provides the consents set out below to enable the Facility to deliver its services, to manage the safety of the Resident and others, to communicate appropriately with the Responsible Person and other authorised parties, and to comply with applicable record-keeping requirements.
Categories of Personal Information Processed
The Facility processes the following categories of the Resident's personal information:
- identification information, including full names, identity number, passport number, date of birth and nationality;
- contact information, including residential address, postal address, telephone numbers and email address;
- next of kin and emergency contact information;
- medical information, including chronic conditions, current medication, allergies, immunisation status, previous hospitalisations and the outcome of any health screening conducted at the Facility;
- mental health information, including diagnosed conditions, treatment received and current treating practitioners;
- substance use history, including substances used, frequency, route of administration, last use, and the outcome of drug and alcohol testing conducted at the Facility;
- criminal and legal information disclosed on admission, including prior convictions, pending charges, parole conditions and protection orders;
- social and family information disclosed on admission, including relationship status, dependants and support network;
- financial information, including fee payment record and banking details where supplied;
- biometric information limited to photographs taken for identification purposes;
- incident records, disciplinary records, drug testing records, medication administration records and progress notes generated during the stay.
Purposes for which Information is Processed
The Resident's personal information is processed for the following purposes:
- the assessment of suitability for admission and the planning of an individual programme;
- the safe delivery of accommodation, meals, group sessions, counselling, mentorship, employment readiness and other services described in the programme;
- the safe management of medication, drug testing and any medical or psychological intervention;
- the management of safety on the premises, including the management of incidents, relapses, conflicts and emergencies;
- communication with the Responsible Person and other authorised parties;
- communication with treating practitioners, including general practitioners, specialists, pharmacists, homeopaths, counsellors, psychiatrists and emergency services;
- communication with employer partners, NGO partners and educational partners for the purpose of employment readiness and reintegration;
- the keeping of operational, financial, medical and incident records as required for the responsible running of the Facility;
- the management of complaints, disputes and legal matters;
- compliance with applicable South African law.
Sharing of Information
The Resident consents to the sharing of personal information with the following categories of third party, to the extent reasonably necessary for the purposes recorded above:
- the Responsible Person nominated by the Resident;
- treating practitioners, including the general practitioner, specialists, the emergency doctor, the certified homeopath, counsellors, psychologists, psychiatrists, pharmacists and ambulance staff;
- hospitals and emergency departments in the event of admission or transfer;
- the pharmacy responsible for packaging the Resident's medication;
- the laboratory or service provider conducting drug and alcohol testing;
- NGO partners, employer partners and educational partners, where the Resident has separately and specifically consented to engagement with that party;
- the South African Police Service, where the Facility is required by law or where the safety of any person reasonably requires;
- the Resident's legal representative, where applicable;
- the Resident's medical aid scheme, where the Resident has authorised the submission of accounts;
- service providers retained by the Facility to assist with the operation of the Facility, subject to appropriate confidentiality undertakings;
- regulators, auditors and professional advisers, where required.
Communication with the Responsible Person
The Resident specifically authorises the Facility to communicate with the Responsible Person on all matters relating to the Resident's stay, including but not limited to:
- admission, progress and discharge;
- leave authorisation and return;
- medical events, including emergencies, hospitalisation, illness and changes in medication;
- mental health events;
- drug or alcohol testing, including positive results;
- relapse incidents and the application of the Relapse Response Procedure;
- disciplinary matters, including the application of penalties or termination;
- fee arrears and financial matters;
- any other matter that, in the reasonable opinion of the Facility, the Responsible Person ought to be informed of.
Additional Authorised Recipients
The Resident authorises the Facility to communicate with the following additional named persons in respect of his stay:
| Full Name | Relationship | Contact Number | Permitted to receive | Initial of Resident | |
|---|---|---|---|---|---|
Restrictions on Communication
The Resident records below any person, organisation or category of person with whom the Facility may not communicate, save in the event of a life-threatening emergency.
| Name / Description | Reason for restriction |
|---|---|
Photographs and Recordings
The Resident records below his consent in respect of photographs, video recordings and audio recordings.
Direct Marketing
The Facility does not use the Resident's personal information for direct marketing of third party goods or services. The Facility may, with the Resident's separate consent, contact the Resident after discharge to invite participation in aftercare, alumni events or follow-up surveys.
Cross-Border Transfer
The Facility does not, as a matter of routine practice, transfer the Resident's personal information outside the Republic of South Africa.
Where cross-border transfer is reasonably required, for example because a third-party service provider hosts data outside South Africa, the Facility will ensure that the recipient is subject to appropriate safeguards.
Retention of Records
The Facility retains the Resident's records for the period reasonably required to meet operational, professional, contractual, tax and legal requirements, and thereafter destroys or de-identifies the records in a secure manner.
Medical, incident and drug testing records are retained for a longer period in line with sound recordkeeping practice.
Security of Information
The Facility takes appropriate technical and organisational measures to safeguard the Resident's personal information against unauthorised access, loss, destruction, alteration and disclosure.
Access to records is limited to staff and contractors who require access for the performance of their duties.
Resident Rights
The Resident has the right, on reasonable notice and during normal business hours, to:
- request access to the personal information held by the Facility;
- request correction of personal information that is inaccurate, incomplete or out of date;
- request the deletion of personal information that is no longer required, subject to the Facility's retention obligations;
- withdraw any consent given in this document, subject to any consent that is required for the lawful operation of the Facility or for the safety of any person;
- lodge a complaint with the Facility Manager and, if not satisfied, with the Information Regulator.
Withdrawal of Consent
Consent may be withdrawn in writing, addressed to the Facility Manager. Withdrawal of consent does not affect the lawfulness of processing carried out before the withdrawal.
The Resident accepts that the withdrawal of certain consents may have a material impact on the ability of the Facility to provide services to him, and may, in some cases, be incompatible with continued residence.
RESIDENT DECLARATION AND CONSENT
I, the undersigned Resident, declare that:
- I have read this Consent in full and understand its contents.
- I have had the opportunity to ask questions and to receive answers regarding the processing of my personal information.
- I understand the categories of information that will be processed, the purposes of processing and the parties with whom my information may be shared.
- I freely and voluntarily give my consent to the Facility to process my personal information for the purposes recorded in this document.
- I confirm the additional authorisations and restrictions recorded above.
RESPONSIBLE PERSON ACKNOWLEDGEMENT
I, the Responsible Person, acknowledge the consents given by the Resident in this document. I undertake to keep all personal information of the Resident, shared with me by the Facility, confidential and to use such information only for the purpose of supporting the Resident's stay and recovery.
FACILITY CONFIRMATION