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Behavioral Health Release of Information This form will allow your behavioral health provider to share protected health information (PHI) with your other providers. This information will not be released
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How to fill out behavioral health release of

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How to fill out behavioral health release of

01
Obtain a behavioral health release of form from the appropriate healthcare provider or facility.
02
Fill out your personal information including your name, date of birth, and contact information.
03
Specify the purpose of the release of information and the duration for which it is valid.
04
Provide the name of the healthcare provider or facility that will be receiving the information.
05
Sign and date the form to authorize the release of your behavioral health information.

Who needs behavioral health release of?

01
Individuals who are seeking to share their behavioral health information with a specific healthcare provider or facility.
02
Patients who are transitioning to a new healthcare provider and want to transfer their behavioral health records.
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Behavioral health release of is a form that allows a patient to authorize the release of their mental health information.
Behavioral health release of is typically filed by mental health providers, counselors, or therapists.
Behavioral health release of can be filled out by providing the patient's name, signature, the specific information to be released, and the recipient of the information.
The purpose of behavioral health release of is to allow an individual to share their mental health information with specific parties, such as other healthcare providers or family members.
The information that must be reported on behavioral health release of includes the patient's diagnosis, treatment plan, medication history, and therapy notes.
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