Consentimiento Informado Templates

Spanish-speaking applicants may use this form to give the Social Security Administration (SSA) permission to release the information from personal SSA files to a specific individual or group.

This Form is used for declaring treatment for mental health in Illinois.

This Form is used for authorizing the release of medical information in California.

This document for residents of Connecticut is a Formulario DCF-2260-S Acepto La Divulgacion De Informacion, which is used for accepting the disclosure of information.

Este documento es utilizado para obtener el consentimiento de evaluación en el estado de Idaho.

This formulario is used for authorization to use and disclose protected health information in Nevada.

This Form is used for Disclosing Limited Health Information (HIPAA) - New York (Spanish).

This type of document is a consent form used in Ohio (Spanish) to authorize the disclosure of information.

This type of document is used for accepting information about a hysterectomy in Ohio, and it is in Spanish.

This document is for obtaining consent for a developmental evaluation of your child in South Dakota.

Este formulario se utiliza para autorizar la divulgación de información médica o de salud a terceros en Tennessee. (Spanish)

This document is a Spanish version of the DCYF Form 15-057SP used in Washington. It is an Aviso Y Consentimiento Para Pruebas De Deteccion (Notice and Consent for Screening Tests) form used by the Department of Children, Youth, and Families (DCYF) in Washington. This form is used for obtaining consent from individuals for diagnostic screenings or tests.

This form is used for recognizing that information about hysterectomy has been received in the state of Illinois. (Spanish)

This document is for obtaining informed consent for a contraceptive implant in New Mexico.

This type of document is used for authorizing school immunization in New Mexico. (Spanish)

This document is used for obtaining authorization to administer medication in Georgia, United States.

This Form is used for authorizing the disclosure of medical information in Texas.

This document for adults seeking treatment for opioid use disorder in Texas. It is a consent form that provides information about the treatment and requires the patient's agreement to undergo the treatment.

This document is a Spanish consent form used for minors between the ages of 13 and 18 who are seeking treatment for opioid use disorder in Texas.

This Form is used for authorizing emergency medical care in Kansas.

This document is a form used by DCYF (Department of Children, Youth, and Families) in Washington State. It is in Spanish and is called "Formulario 15-054 Aviso Y Consentimiento Para Evaluacion/Valoracion" which translates to "Notice and Consent for Evaluation/Assessment". It is used to obtain consent and inform individuals about the evaluation or assessment process.

This document is an authorization form used in Arkansas that allows parents to access information about medical plans and disclose personal identification information.

This document is used for revoking parental consent for placement in Arkansas.

This Formulario DHS-4000 Autorizacion Para Proveer Informacion Medica - Arkansas is used for authorizing the release of medical information in the state of Arkansas.

This document is for obtaining informed consent from a tenant in New York regarding individual improvements to their apartment.

This document for parents in Rhode Island gives permission for the administration of medication in schools.

This form is used for authorizing the disclosure of information in Texas.