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COMPEER PROGRAM REFERRAL RELEASE AUTHORIZATION TO EXCHANGE CLINICAL INFORMATION, hereby authorize the staff of the Compeer (CLIENTS NAME)Program and to exchange information or records, (PROVIDER/PROVIDING

How to fill out compeer program referral release

How to fill out compeer program referral release

1. Obtain the compeer program referral release form from the program coordinator.
2. Read the form carefully to understand the purpose and consequences of signing it.
3. Fill in your personal details such as name, address, phone number, and date of birth.
4. Provide accurate information about your mental health history and current condition.
5. Ensure that all the sections of the form are properly filled out.
6. If you have any questions or concerns, don't hesitate to ask the program coordinator for clarification.
7. Review your completed form for accuracy and completeness.
8. Sign and date the form to authorize the release of your referral information to the compeer program.
9. Keep a copy of the filled-out form for your records.
10. Submit the form to the program coordinator or follow the designated submission process.

Who needs compeer program referral release?

1. Anyone who wishes to participate in the compeer program as a referral needs to fill out the compeer program referral release.

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What is compeer program referral release?

The Compeer Program Referral Release is a document that allows for the sharing of information between organizations and individuals regarding a participant's involvement in the Compeer Program, which connects volunteers and individuals in need of companionship.

Who is required to file compeer program referral release?

Individuals who are participants in the Compeer Program and organizations that facilitate the program are required to file the referral release.

How to fill out compeer program referral release?

To fill out the Compeer Program Referral Release, you need to provide your personal information, details of the agency or individual to whom the release is being sent, and authorize sharing of information by signing the document.

What is the purpose of compeer program referral release?

The purpose of the Compeer Program Referral Release is to ensure that relevant information about participants can be shared among service providers to enhance support and coordination of services.

What information must be reported on compeer program referral release?

The information that must be reported includes the participant's name, contact information, details about the referral agency, and specific consent for the sharing of information.