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Get the free SWIMHC interagency release form updated 6-23-16 - MHDS

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Interagency Release Form AUTHORIZATION FOR DISCLOSURE AND RELEASE OF MEDICAL, MENTAL HEALTH, SUBSTANCE ABUSE, AND/OR CORRECTIONS INFORMATION Applicant/Participant Birthdate I, the undersigned, authorize
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How to fill out swimhc interagency release form

01
Read the swimhc interagency release form carefully to understand the purpose and requirements.
02
Fill in your personal information accurately, including your name, contact information, and any other requested details.
03
Indicate the specific agencies or individuals with whom you authorize the release of your swimhc records.
04
Specify the dates or time period for which the release should be effective.
05
Sign and date the form to validate it.
06
Consider making a copy of the completed form for your records before submitting it.
07
Submit the form to the designated authority or agency as instructed.

Who needs swimhc interagency release form?

01
Individuals who have received treatment or services from swimhc (Swim Mental Health Center).
02
Individuals who want to authorize the release of their swimhc records to specified agencies or individuals.
03
Individuals who are involved in interagency collaboration or coordination that requires the sharing of swimhc records.
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The swimhc interagency release form is a document that allows the sharing of mental health and substance use treatment information between different agencies or entities.
Individuals receiving mental health and substance use treatment services, as well as those providing these services, may be required to file the swimhc interagency release form.
To fill out the swimhc interagency release form, one must provide their personal information, specify the agencies authorized to share information, and sign the form to indicate consent.
The purpose of the swimhc interagency release form is to facilitate the coordinated care and treatment of individuals by allowing relevant agencies to share mental health and substance use treatment information.
The swimhc interagency release form typically requires the individual's identifying information, the names of authorized agencies, the duration of consent, and any specific information or records to be shared.
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