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SABRE COUNSELING SERVICES Megan Sabre, LCSW 34121 N. Highway 45, Suite 212 Grayslake, IL 60030 pH: (847) 3097316 Fax: (847) 9866845 AUTHORIZATION FOR RELEASE OF MENTAL HEALTH, ALCOHOL & DRUG ABUSE
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How to fill out consent to release information:

01
Start by writing your full name and contact information at the top of the form.
02
Indicate the purpose of the release of information by specifying the recipient or organization that will be receiving the information.
03
Clearly state the type of information you are giving consent to release. This could include medical records, educational records, or any other specific category.
04
Specify the timeframe for which the consent is valid. You can choose to provide a specific date range or indicate that the consent is ongoing until revoked.
05
Sign and date the form to indicate your authorization. If necessary, you may also have a witness sign the form.
06
Keep a copy of the signed consent form for your records.

Who needs consent to release information:

01
Generally, individuals or organizations that are bound by privacy laws and regulations require consent to release information. This can include healthcare providers, educational institutions, employers, and government agencies.
02
Consent is typically needed when sharing personal information with a third party, such as another healthcare provider or insurance company, for medical treatment, insurance claims, or other purposes.
03
Depending on the specific circumstances and jurisdiction, consent may also be required when sharing personal information with family members, legal representatives, or others involved in the individual's care or legal matters.
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Consent to release information is a form signed by an individual giving permission for their personal information to be shared with designated parties.
Any individual who wishes to have their personal information shared with specific parties must file consent to release information.
Consent to release information can be filled out by providing all required personal information, specifying the parties with whom the information can be shared, and signing the form.
The purpose of consent to release information is to ensure that individuals have control over who can access their personal information and to protect their privacy.
Consent to release information typically includes personal details of the individual, the designated parties who can access the information, and the type of information being shared.
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