BCFC - NCMI Hub Information Sharing Agreement This field is hidden when viewing the formGUIDThis field is hidden when viewing the formreqCodeThis field is hidden when viewing the formuserEmail This field is hidden when viewing the formGUTYPEThis field is hidden when viewing the formSubmission Date (Admin Only) MM slash DD slash YYYY The Bilal Newcomer Community Mobilization Initiative (NCMI) Hub is an advisory group that works to coordinate and mobilize services for individuals/families facing barriers within systems. I authorized to represent and agree to share information on individuals/families participating in Bilal NCMI from the agency/sector I am representing during Hub discussions for the purposes of mobilizing systems and services to assist the individual/family with safety and wellbeing. I understand that information sharing across systems and sectors is crucial to the success of the Bilal NCMI Project. I understand my roles and responsibilities associated with information sharing as follows: I will only share identifying and relevant information if the participating individual/family has given verbal or written informed consent. I will only share personal and individual/family information relevant to the current situation. I will keep all information heard from other Hub members in the strictest of confidence. I will not use the information or disclose information to anyone outside of the Hub, unless it is required to provide services by the agency/sector I am representing. I understand that immediate risk to self-harm or to harm another person must be reported to the appropriate authorities. I understand that the Bilal NCMI staff will share important advice/suggestions of the hub information back to the individual/Family Liaison and the Support Team that is relevant to the plan developed. I understand that all other Hub members present at the Hub table are also bound by this agreement and the same confidentiality. Hub Member informationMy Name(Required)My Agency NameHub Member Signature(Required)Witness informationWitness TitleWitness Name(Required)Witness Signature(Required) Note: The witness should be a member of the Bilal NCMI.