Form SUPCR1133 Authorization for Use, Exchange, and / or Discharge of Confidential Substance Use Disorder - County of Santa Cruz, California

What Is Form SUPCR1133?

This is a legal form that was released by the Board of Supervisors - County of Santa Cruz, California - a government authority operating within California. The form may be used strictly within County of Santa Cruz. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is SUPCR1133?A: SUPCR1133 is a form for authorization of use, exchange, and/or discharge of confidential substance use disorder information.

Q: Who is it for?A: It is for residents of Santa Cruz County, California.

Q: What is the purpose of SUPCR1133?A: The purpose is to provide consent for the release and sharing of confidential substance use disorder information.

Q: What does the form authorize?A: The form authorizes the use, exchange, and/or discharge of confidential substance use disorder information by authorized individuals and organizations.

Q: Is the form mandatory?A: No, it is not mandatory. It is optional for individuals who want to authorize the release of their confidential substance use disorder information.

Q: How long is the authorization valid?A: The authorization is valid for one year from the date it is signed, unless otherwise specified.

Q: Can I revoke the authorization?A: Yes, you can revoke the authorization at any time by submitting a written revocation.

Q: Who can I contact for more information?A: For more information, you can contact the County of Santa Cruz, California.

Q: Is there a fee for submitting the form?A: No, there is no fee for submitting the form.

Q: What happens if I don't submit the form?A: If you don't submit the form, your confidential substance use disorder information will not be shared or exchanged without your authorization.