Release Consent Form.pdf

AD-Individual-Release-of-Information.pdf
Preview of Release Consent Form
🔗 Source: fourcounty.com
📊 Size: 294 KB
👤 Author: Hillary Arnold
⬇️ Downloads: 131

Summary

I HEREBY AUTHORIZE Four County Mental Health Center to release and/or obtain confidential information, including SUD assessment, treatment plans, and progress notes, for care coordination, processing information, or as requested by patient/parent/guardian, with consent expiring one year from the date signed unless revoked in writing.

Description

I HEREBY AUTHORIZE Four County Mental Health Center to release and/or obtain confidential information, including SUD assessment, treatment plans, and progress...

Technical Information

  • File Format: PDF
  • File Size: 294 KB
  • Pages: 1
  • Language: EN
  • Author: Hillary Arnold
  • Total Downloads: 131
  • Last Updated: 1 week ago

Document Overview

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