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Tatiana Matthews LPC Authorization to Release/Receive Health Information (This form applies only to the release and disclosure of information. It is not a consent for treatment or intended for any

How to fill out tatiana matformws lpc authorization

How to fill out Tatiana Matformws LPC authorization:

1. Start by downloading the Tatiana Matformws LPC authorization form from the official website or source where it is provided.
2. Read the instructions carefully to understand the requirements and purpose of the authorization form. This will help you gather the necessary information and ensure you fill out the form accurately.
3. Begin by entering your personal information in the appropriate fields. This may include your full name, contact details, address, and any identification numbers requested.
4. Provide the necessary details about the LPC (Licensed Professional Counselor) for whom the authorization is being granted. This can include their name, contact information, professional license number, and any other requested information to identify them.
5. Specify the duration of the authorization by filling in the start and end dates, or any time restrictions mentioned in the form.
6. Review the specific permissions or actions being authorized. This may include accessing your personal records, sharing information with other healthcare professionals, or conducting specific treatments or interventions.
7. Sign and date the form to indicate your consent and agreement.
8. If required, have a witness sign as well.
9. Keep a copy of the completed form for your records before submitting it to the appropriate recipient.

Who needs Tatiana Matformws LPC authorization:

1. Individuals who are seeking counseling or therapy services from Tatiana Matformws, an LPC (Licensed Professional Counselor), may need to provide authorization.
2. Healthcare professionals or organizations who require documented proof of consent to access, share, or disclose a patient's personal information or medical records from Tatiana Matformws may ask for this authorization.
3. Any person or entity who needs legal proof of authorization to perform specific actions or make decisions on behalf of the person granting the authorization may require Tatiana Matformws LPC authorization.

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