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MENTAL HEALTH RECORDS RELEASE FORM (9/22) (PAGE 1 of 2) How to Get Client Records & Who Must Authorize Release of Information Please complete this form in full to request a release of information
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How to fill out mental health records release

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How to fill out mental health records release

01
Obtain a mental health records release form from the healthcare provider.
02
Fill in your personal information, such as name, date of birth, and contact information.
03
Specify the dates for which you are authorizing the release of your mental health records.
04
Include the name and contact information of the recipient who will be receiving the records.
05
Sign and date the form to confirm your consent to release your mental health records.

Who needs mental health records release?

01
Individuals who are seeking to share their mental health records with another healthcare provider.
02
Patients who are participating in therapy and want to authorize their therapist to share their mental health records with a third party.
03
Individuals who are applying for disability benefits and need to provide their mental health records as part of their application.
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Mental health records release is a form that allows a patient to authorize the disclosure of their mental health records to a specified individual or organization.
Patients or their legal representatives are typically required to file a mental health records release form.
To fill out a mental health records release form, the patient or their legal representative must provide their personal information, specify the records to be released, and indicate who the records should be released to.
The purpose of mental health records release is to allow the sharing of mental health information between healthcare providers, caregivers, or other authorized individuals for treatment or other healthcare-related purposes.
The mental health records release form typically requires information such as the patient's name, date of birth, the specific information to be released, the individual or organization receiving the information, and the duration of the release.
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