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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.
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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