Sample Consent to: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records - Alabama

Sample Consent to: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records - Alabama

Sample Consent to: Third-Party Payer 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 consent?
A: To authorize disclosure of confidential substance abusepatient records to a third-party payer.

Q: Who is the consent given to?
A: The consent is given to a third-party payer.

Q: What kind of records are being disclosed?
A: Confidential substance abuse patient records.

Q: Is this consent specific to Alabama?
A: Yes, this consent is specific to Alabama.

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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: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records - Alabama

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