Counseling release of information template 2025

1. Click ‘Get Form’ to open the counseling release of information template in the editor.
2. Begin by entering the patient's name, date of birth, and social security number in the designated fields. This information is crucial for identifying the individual whose records are being released.
3. Fill in the address and phone number of the patient. Ensure that all contact details are accurate to facilitate communication.
4. In the authorization section, indicate whether you authorize River Crest Hospital to provide or request information by checking the appropriate box.
5. Specify the counselor's name and school district, along with their contact details. This ensures that the right professional receives or sends information.
6. Select which types of information you wish to be released by checking the relevant boxes, such as discharge summaries or psychiatric evaluations.
7. Complete the purpose of disclosure section by selecting from options like evaluation and treatment or personal use.
8. Finally, ensure that all required signatures are provided at the bottom of the form, including those from guardians if applicable.

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