PDF
Word
Sample Consent to: Entity With a Treating Provider Relationship Authorizing Disclosure of Confidential Sud Patient Records - Alabama
Sample Consent to: Entity With a Treating Provider Relationship 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 form?A: The purpose of the consent form is to authorize the disclosure of confidential substance abusepatient records.
Q: Who can disclose the patient records?A: Only entities with a treating provider relationship can disclose the patient records.
Q: What type of records are covered by the consent?A: The consent covers confidential substance abuse patient records.
Q: Who needs to sign the consent form?A: The patient or their legally authorized representative needs to sign the consent form.
Form Details:
- 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 With a Treating Provider Relationship Authorizing Disclosure of Confidential Sud Patient Records - Alabama
1
2
