Get Consent Form Ce To Dbhdd.pdf - Dui Intervention Program Website - Mop Uga

Filling out the Consent Form CE To DBHDD is an important step in participating in the DUI intervention program. This guide provides clear and detailed instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the consent form

1. Click the ‘Get Form’ button to obtain the form and open it in your selected document editor.
2. Begin by entering your name in the section labeled 'Name of Client.' This identifies the individual providing consent.
3. Next, input the name of the clinical evaluator in the 'Name of DBHDD Clinical Evaluator' field to specify who will be sharing information.
4. In the designated area, outline the specific information that is being authorized for disclosure, including the results of your clinical evaluation and any other relevant details necessary for treatment referrals.
5. Clearly state the purpose of the disclosure. This should explain that the information is intended to allow the Department of Behavioral Health & Developmental Disabilities to evaluate and approve recommendations from your clinical evaluator.
6. Acknowledge the confidentiality of your records by reviewing the statement regarding the Federal regulations. This assures you that your information is protected and will only be released under the stated circumstances.
7. Provide the expiration date for the consent. This can be a specific date or, in this case, six months after the completion of your clinical evaluation.
8. Finally, sign the form in the 'Client Signature' section and date it to confirm your consent and understanding of the document.
9. Once you have completed the form, you can save your changes, download a copy, print it for your records, or share it as necessary.

Complete your Consent Form online today to ensure your participation in the DUI intervention program.