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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION La Hacienda Treatment Center, P.O. Box 1, Hunt, TX 78024, Phone: (800) 7496160, Fax: (830) 2386119 Please read this entire form before signing
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La Hacienda Treatment Center is a rehabilitation facility that specializes in helping individuals recover from addiction and substance abuse.
Patients or their legal guardians are required to provide information for the filing of La Hacienda Treatment Center.
To fill out La Hacienda Treatment Center, individuals need to provide personal and medical information as requested by the facility.
The purpose of La Hacienda Treatment Center is to provide a supportive and structured environment for individuals to overcome addiction and start on the path to recovery.
Information such as medical history, current medications, addiction severity, and personal contact details must be reported on La Hacienda Treatment Center.
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