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Commonwealth of Massachusetts Department of Mental Health (DM) Release of Information for Social Supports 1. Patient/Applicant Information Name: ___Other Names: ___Street: ___APT.#: ___City/Town:

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This release does not include information pertaining to certain exemptions and does not cover procedures for appeal.

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This release does not require filing from individuals or entities that fall into specific exempt categories outlined by the governing body.

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The purpose of this release does not encompass the notification of changes in applicable laws or regulations.

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This release does not need to report information that is unrelated to the primary focus of the filing, such as external financial data.

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