Inter-Agency Contact Form to Portsmouth Multi-Agency Safeguarding Hub (MASH) This form may be posted, transmitted by fax, or sent as an email attachment from a secure email address: By email to: By post to: Portsmouth MASH, Civic Offices, Floor 4 Core 5/6, PO1 2EA By fax to: 023 9275 4709 Telephone: Office hours: 023 9268 8793 or 0845 671 0271 Telephone: Out of hours: 0300 555 1373 (17:00-08:30 Monday-Thursday, 16:30-08:30 Friday and 24 hrs weekends & bank holidays) Details of person making Contact Name: Role: Organisation/Agency: Address: Post code Tel No: Date: Parental/Guardian Consent to Sharing Information All Contacts to the Portsmouth MASH should be made with the knowledge and agreement of the family. They need to know what information has been shared and recorded by the Portsmouth MASH. They must also be aware that the Portsmouth MASH may need to share information with, and to seek information from other agencies to help them decide if additional services are needed, e.g. schools, health visitors, doctors, police, housing etc. The exception to this is when seeking consent to share information would put a child, young person or others at risk of significant harm, or if it would undermine the prevention, detection or prosecution of a serious crime. In these circumstances the Portsmouth MASH and/or Children’s Social Care teams may seek and share necessary information about a child, young person or family without consent being given. I the parent/guardian understand the above and agree to the sharing of personal information between agencies as described. I also understand that the information provided will be stored on a Children’s Social Care database and that I may see the records held by Children’s Social Care that directly concern me. I the professional making the contact has explained the above to the parent/guardian who has agreed to the Contact but has not been able to sign to that effect. Signed: Print name: Relationship to Date: If verbal consent has been given by parent/guardian please document how this contact was made i.e. telephone, and when it was given. If consent was not given please give the reasons why it is still being made:
Inter-Agency Contact Form to Portsmouth Multi-Agency Safeguarding Hub (MASH) This form may be posted, transmitted by fax, or sent as an email attachment from a secure email address: By email to: By post to: Portsmouth MASH, Civic Offices, Floor 4 Core 5/6, PO1 2EA By fax to: 023 9275 4709 Telephone: Office hours: 023 9268 8793 or 0845 671 0271 Telephone: Out of hours: 0300 555 1373 (17:00-08:30 Monday-Thursday, 16:30-08:30 Friday and 24 hrs weekends & bank holidays) Details of person making Contact Name: Role: Organisation/Agency: Address: Post code Tel No: Date: Parental/Guardian Consent to Sharing Information All Contacts to the Portsmouth MASH should be made with the knowledge and agreement of the family. They need to know what information has been shared and recorded by the Portsmouth MASH. They must also be aware that the Portsmouth MASH may need to share information with, and to seek information from other agencies to help them decide if additional services are needed, e.g. schools, health visitors, doctors, police, housing etc. The exception to this is when seeking consent to share information would put a child, young person or others at risk of significant harm, or if it would undermine the prevention, detection or prosecution of a serious crime. In these circumstances the Portsmouth MASH and/or Children’s Social Care teams may seek and share necessary information about a child, young person or family without consent being given. I the parent/guardian understand the above and agree to the sharing of personal information between agencies as described. I also understand that the information provided will be stored on a Children’s Social Care database and that I may see the records held by Children’s Social Care that directly concern me. I the professional making the contact has explained the above to the parent/guardian who has agreed to the Contact but has not been able to sign to that effect. Signed: Print name: Relationship to Date: If verbal consent has been given by parent/guardian please document how this contact was made i.e. telephone, and when it was given. If consent was not given please give the reasons why it is still being made:
Inter-Agency-Contact-Form-July-2017.docx