that an individual or an individual's guardian has the option
not to answer an LGBTQ identifier on all blanks, forms,
documents and applications in a clear and conspicuous manner. A
third-party, including a health care provider or State employee,
may not have the authority to act on behalf of an individual for
the purpose of opting not to answer an LGBTQ identifier. A
Commonwealth agency or entity shall include the option not to
answer an LGBTQ identifier on all blanks, forms, documents and
applications in substantially the following form:
You are not required to answer the LGBTQ identifier as a
condition of receiving a service or benefit from the
Commonwealth agency or entity or attaining or maintaining
employment with the Commonwealth agency or entity. The
Commonwealth agency or entity may not disclose your
answer to the LGBTQ identifier to the public in a manner
that will identify your personal information, including
your name, age, residence address, family members or
other similar information. The Commonwealth agency or
entity may not use your answer to the LGBTQ identifier as
the basis to discriminate against you regarding the
provision of a service or benefit from the Commonwealth
agency or entity or attaining or maintaining employment
with the Commonwealth agency or entity.
(d) Form.--A Commonwealth agency or entity shall design an
LGBTQ identifier as follows:
(1) The LGBTQ identifier may not infringe or threaten to
infringe on an individual's mental or physical well-being.
(2) The LGBTQ identifier shall include a designation for
nonbinary individuals.
(3) The LGBTQ identifier shall be consistent with the
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