Texas Department of Aging and Disability Services Form 0067 May 2005 Consent by Roommate for Authori-2025

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Texas Department of Aging and Disability Services Form 0067 May 2005 Consent by Roommate for Authori Preview on Page 1

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the resident in the designated field at the top of the form.
  3. Next, provide your name as the requestor in the appropriate section.
  4. Indicate your consent for authorized electronic monitoring by filling in the name of the resident or requestor who will conduct the monitoring.
  5. Check all applicable options regarding restrictions on electronic monitoring. If using a video camera, specify where it should not be pointed.
  6. If applicable, outline any circumstances under which audio monitoring is prohibited.
  7. Finally, ensure that you sign and date the form as either the resident, guardian, or legal representative.

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