Consent For Release Of Confidential Information About Alcohol Or Drug Information

Form Template

The "Consent For Release Of Confidential Information About Alcohol Or Drug Information" app is a easy tool to collect approvals from the patient.

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By filling and signing this consent form, you are allowing your health records listed on this form to be disclosed through a secure computer network operated by health care providers whom you identify, that are a part of the CSOC network. The purpose of sharing your health care information is to provide you with, better, more coordinated treatment. All drug, alcohol, mental health and physical health care providers or other entities participating will be able to share (disclose and receive) their records to the health care providers you identify. This will include all places that have provided you services. This includes, drug and alcohol programs, mental health programs, psychologists, clinics, hospitals, clinical laboratories, pharmacies, physicians, health care insurers, Medicare, Medicaid, etc. This app is ideal for health care providers.

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