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53 <br />Section IV: Duties Relating to Right of Subjects <br />Section 13.04, subdivision 2, requires that government entities give a notice to an individual whenever the <br />• entity asks the individual to provide private or confidential data about her/hi <br />mself. The notice is called a <br />Tennessen warning notice . The notice must state 1) the purpose and intended use of the data being <br />collected, 2) whether the individual may refuse to supply the data or is required by law to supply the data, 3) <br />the consequences of either supplying or refusing to supply the information, and 4) the identities of all those <br />who are authorized by law to access the data. <br />Section 13.05, subdivision 4, limits the subsequent use and dissemination of private or confidential data, <br />collected from an individual, to what was described in the Tennessen warning notice. If the entity wishes to <br />use or release the data in a way not communicated in the Tennessen warning notice, this statutory section <br />requires the entity to obtain the individual's informed consent. The standards for obtaining an informed <br />consent are set out at Minnesota Statutes section 13.05, subdivision 4(d) and Minnesota Rules, part <br />1205.1400. <br />(In lieu of obtaining informed consent from the data subject, an entity may use or disseminate private data <br />for a new purpose with the approval of the Commissioner of the Minnesota Department of Administration <br />pursuant to Minnesota Statutes section 13.05, subd. 4(c) and Minnesota Rules, part 1205.1400.) <br />This model consent form meets all of the above standards and, as a general rule, may be used by any entity <br />or person who is subject to the MGDPA. Entities may tailor this form to accommodate their specific needs; <br />however, if alterations to the language on this form are significant, an informed consent obtained by using <br />• the altered form may fail to meet legal requirements. (For example, some members of family services <br />collaboratives would like a consent form that requires completion only once and which accommodates all <br />possible releases of data between or among a number of entities. Suggestions have included designing a <br />check off system consisting of various boxes that represent entities and types of data. Although such a form <br />might be convenient for entities that routinely share varying types of private data with other entities, it likely <br />would not meet the legal standards for an informed consent.) <br />This consent form is not appropriate for use in situations where the specific form and content of an informed <br />consent are dictated bylaw. (For example, see Minnesota Statutes section 13.05, subdivision 4(a) (1)-(7).) <br />CONSULT YOUR LEGAL ADVISOR BEFORE USING THIS OR ANY OTHER CONSENT FORM. <br />This is especially important where use of the consent form may present issues of compliance with other laws <br />such as the Americans with Disabilities Act, or with the requirements relating to the release of data about <br />minor children. <br />The model form, appearing on the next page, is addressed to the data subject. Instructions to government <br />entities for completing the form appear on its reverse. <br />July, 2000 Model Policy: Access to Government Data & Rights of Subjects Data <br />