Get the free Employee Assistance Program AUTHORIZATION FORM

FAR WEST FAMILY SERVICES Employee Assistance Program AUTHORIZATION FORM Authorization to Use and Disclose Protected Health Information 1. I (print name) am I completing this form to allow the use

How to fill out employee assistance program authorization

How to fill out employee assistance program authorization:

1. Obtain the necessary forms: Begin by obtaining the employee assistance program authorization form from your human resources department or directly from the EAP provider. Make sure you have the most up-to-date version of the form.
2. Fill in personal information: Start by filling in your personal information, such as your full name, employee identification number, contact information, and the date of the request. Ensure that all information is accurate and up-to-date.
3. Specify the reason for seeking assistance: In this section, briefly outline the reason why you are seeking assistance through the employee assistance program. This could be related to personal issues, stress management, mental health concerns, substance abuse, or any other area where you require support.
4. Consent to release of information: The employee assistance program authorization form typically includes a section where you need to provide consent to release information to relevant parties. This is important for maintaining confidentiality and allowing the EAP provider to collaborate with your employer or healthcare professionals if necessary. Make sure to read and understand this section before signing.
5. Sign and date the form: Once you have completed filling out the necessary information, sign and date the form. Your signature indicates your consent and agreement to the terms and conditions outlined in the authorization form.

Who needs employee assistance program authorization:

1. Employees facing personal challenges: Any employee who is experiencing personal challenges or difficulties that are impacting their overall well-being, work performance, or mental health may need employee assistance program authorization. This includes individuals dealing with stress, relationship issues, substance abuse, depression, anxiety, or any other personal problem affecting their ability to function optimally.
2. Employers offering EAP benefits: Employers who offer an employee assistance program as a part of their benefits package may require employees to go through the authorization process. This helps in maintaining the security and confidentiality of the services provided by the EAP and ensures that employees are accessing the program appropriately.
3. Employers and EAP providers: Employers and EAP providers also have a role in authorizing and facilitating the employee assistance program. They may require employees to complete the authorization form to have a documented record of their consent and to maintain confidentiality between the employee and the EAP provider.

In summary, the process of filling out an employee assistance program authorization involves obtaining the necessary forms and providing accurate personal information, specifying the reason for seeking assistance, consenting to the release of information, and signing the form. The authorization is typically required for employees facing personal challenges, employers offering EAP benefits, and employers and EAP providers involved in facilitating the program.

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