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Tanya Limbaugh, LCSW64783 11344 Coloma Rd., Suite 250 Gold River, CA 95670 (530) 2957006 CONSENT TO USE AND DISCLOSE YOUR HEALTH INFORMATION This form is an agreement between you, and me, Tanya Limbaugh,
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Tanya Grubaugh LCSW64783 11344 refers to a specific form or document related to a licensed clinical social worker.
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The purpose of the form is likely for regulatory compliance and monitoring of licensed clinical social workers.
Information such as client demographics, treatment provided, sessions conducted, and other details related to the social worker's practice may need to be reported.
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