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Information to be used or disclosed in connection with Pediatric Mental Health Care Access Program Authorization for Disclosure of Protected Health Information Patient Name: Date of Birth: Address:
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Go to the Family Voices of North website.
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Who needs family voices o north?

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Families who have children with special healthcare needs
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Family Voices of North is a non-profit organization that advocates for families of children with special health care needs.
Families or caregivers of children with special health care needs are required to file Family Voices of North.
To fill out Family Voices of North, you can visit their website and follow the instructions provided.
The purpose of Family Voices of North is to provide support and advocacy for families of children with special health care needs.
Information such as the child's health care needs, services received, challenges faced, and any support required must be reported on Family Voices of North.
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