Consent For Release Of Confidential Information About Alcohol Or Drug Information Mobile App

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.

  • Apple
    iPhone, iPad
  • Android
    Android
  • Window
    Windows

Why Customers Love GoCanvas

Reduces paperwork
Tracks jobs & expenses
Shows real-time data
Affordable plans
How It Works
I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.

Dave Kramer

PennLine Service

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