Health Info Disclosure Form.pdf

6c3e94_7983701a2d17410181c1b8db4e0e4321.pdf
Preview of Health Info Disclosure Form
🔗 Source: ohrs.org
📊 Size: 162 KB
👤 Author: Jessica Shook
⬇️ Downloads: 81

Summary

CLIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION: Client authorizes Olympic Health & Recovery Services and Thurston Mason Behavioral Health Administrative Services Organization to exchange records with a specified person/organization, including outpatient mental health, medical history, progress notes, and treatment plans, with the understanding that disclosed information may be redisclosed and no longer protected by privacy laws.

Description

CLIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION: Client authorizes Olympic Health & Recovery Services and Thurston Mason Behavioral...

Technical Information

  • File Format: PDF
  • File Size: 162 KB
  • Pages: 1
  • Language: EN
  • Author: Jessica Shook
  • Total Downloads: 81
  • Last Updated: 7 days ago

Document Overview

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