St. Mary's County Department of Aging & Human Services Community Health & Wellness Fair 2023

St. Mary's County Department of Aging & Human Services Informed Consent

NOTICE

• The information you provide will be used to (1) help improve programs for seniors, or (2) find out if you qualify for a program. It may be shared with the Maryland Department of Aging ("MDoA").
• The Commissioners of St. Mary's County through the Department of Aging & Human Services, and MDoA will not voluntarily share any information that identifies you with anyone except people working for them who need the information to perform their jobs. Information that identifies you include your name, address, and telephone number.
• You may refuse to give some or all of the information requested. However, if a program is only for people who meet its qualifications (such as age, income, or health condition) and you do not share the information that show you qualify, then you will not be able to take part in that program. St. Mary's County Department of Aging & Human Services staff can tell you what information is needed to show you qualify for a program.
• You may review a record that identifies you. You may do this to make sure the information is accurate. To review records you must write to St. Mary's County Department of Aging & Human Services, Attention AIM/NAPIS Administrator, P.O. Box 653, Leonardtown, MD 20650 or Maryland Department of Aging, Attention AIM/NAPIS Administrator, 301 West Preston Street, Suite 1007, Baltimore, MD 21201.