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Disability Services Consent for Release of Information I, give full permission to the Counseling Services Department to contact the resource person(s) and/or treatment facility listed below and to
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What is release of information form?
Release of information form is a document that allows the disclosure of an individual's confidential and protected health information to a third party.
Who is required to file release of information form?
The individual or legal guardian of the individual is required to file the release of information form.
How to fill out release of information form?
To fill out the release of information form, the individual needs to provide their personal information, specify the information to be disclosed, the purpose of disclosure, and sign the form.
What is the purpose of release of information form?
The purpose of release of information form is to authorize the release of an individual's confidential information to a specified party.
What information must be reported on release of information form?
The release of information form must include the individual's personal information, the specific information to be disclosed, the purpose of disclosure, and the signature of the individual or legal guardian.
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