Sample Consent to: Entity Without a Treating Provider Relationship & Participants Authorizing Disclosure of Confidential Sud Patient Records - Alabama

Sample Consent to: Entity Without a Treating Provider Relationship & Participants Authorizing Disclosure of Confidential Sud Patient Records - Alabama

Sample Consent to: Entity Without a Treating Provider Relationship & Participants Authorizing Disclosure of Confidential Sud Patient Records is a legal document that was released by the Alabama Department of Mental Health - a government authority operating within Alabama.

FAQ

Q: What is the purpose of the document?
A: The document is for obtaining consent from patients in Alabama to disclose their confidential substance abuse treatment records.

Q: Who is the intended recipient of the disclosed records?
A: The disclosed records may be shared with an entity that does not have a treating provider relationship with the patient.

Q: What does the document require from the patients?
A: The document requires patients to authorize the disclosure of their confidential substance abuse treatment records.

Q: Why would someone need to sign this document?
A: Signing this document allows for the sharing of their substance abuse treatment records with an entity without a treating provider relationship.

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Form Details:

  • Released on January 1, 2018;
  • The latest edition currently provided by the Alabama Department of Mental Health;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

Download Sample Consent to: Entity Without a Treating Provider Relationship & Participants Authorizing Disclosure of Confidential Sud Patient Records - Alabama

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