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Authorization/Release Forms

Below are links to two authorization/release forms.  These forms are important because they allow health information of a recently incarcerated or hospitalized mentally ill individual to be shared with their family and designated agencies, individuals or health care providers.

Family Authorization Form 03-01A: This form authorizes Community Mental Health Services  to release protected health information to identified family/support Members. Community Mental Health Services encourages clients to include family in their treatment planning. Family is support people, friends and significant others. Family Partnership is an important element of recovery from mental illness.

Authorization Release Form 03-01: This form authorizes Community Mental Health Services to exchange protected health information with designated agencies, individuals, or health care providers.