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Name by Bay Area Behavioral Services in order to provide clinical/ therapeutic services to Client Name. BAY AREA BEHAVIORAL SERVICES 135 North Moon Avenue Brandon Florida 33510 AUTHORIZATION FOR RELEASE OF INFORMATION BETWEEN Communication between your Primary Care Physician and Bay Area Behavioral Services may be beneficial to your treatment process. Bay Area Behavioral Services to my Primary Care Physician Dr. Name regarding clinical/therapeutic services provided to Client Name. Such...

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Step 1: Start by downloading the Lisa Friedman Auth Release of Info Babs PCP form from an authorized source.

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Step 3: Provide your personal information accurately, including your full name, contact details, and any relevant identification numbers.

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Step 4: If applicable, provide the name and contact information of your Primary Care Physician (PCP).

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Step 5: Specify the purpose of releasing the information and the duration for which the authorization is valid.

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Step 6: Read the privacy notice section and acknowledge your understanding of the possible implications of releasing your medical information.

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Step 7: Sign and date the form.

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Step 8: If required, have a witness sign the form as well.

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Individuals who require the release of their medical information from Lisa Friedman to their Primary Care Physician (PCP) need Lisa Friedman Auth Release of Info Babs PCP.

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This form is essential for patients who want to grant permission for the disclosure of their medical records to their PCP.

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