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AUTHORIZATION FOR RELEASE OF MENTAL HEALTH INFORMATION, ___, Date of Birth: ___Social Security Number: ___, hereby authorize: Stadia AlizaiCowan, M.D. 5530 Wisconsin Avenue, Ste 965 Chevy Chase, MD

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How to fill out mental health records release

01

Obtain the appropriate mental health records release form from the healthcare provider

02

Fill in your personal information, including name, date of birth, and contact information

03

Specify the information you would like to release and to whom it should be released

04

Sign and date the form in the designated areas

05

Review the form for accuracy and completeness before submitting it to the healthcare provider

Who needs mental health records release?

01

Individuals seeking to transfer their mental health records to a new healthcare provider

02

Patients who wish to share their mental health information with another healthcare professional or facility

03

Legal representatives or advocates assisting a patient with their healthcare needs

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What is mental health records release?

Mental health records release is a legal document that allows the disclosure of an individual's mental health information to authorized entities or individuals.

Who is required to file mental health records release?

The individual or their legal guardian is typically required to file a mental health records release.

How to fill out mental health records release?

To fill out a mental health records release, one must provide personal information, specify the information to be released, and sign the form.

What is the purpose of mental health records release?

The purpose of mental health records release is to grant permission for the release of mental health information to designated parties for specific purposes.

What information must be reported on mental health records release?

The information reported on a mental health records release may include the individual's name, date of birth, type of information to be released, and the authorized recipient.

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