Get 11059 East Bethany Drive Suite 200 Aurora Co 80014 - Health Aurorak12

This guide offers a detailed overview of how to complete the 11059 East Bethany Drive Suite 200 Aurora CO 80014 - Health Aurorak12 form online. Follow the steps outlined below to ensure that your submission is accurate and complete.

Follow the steps to fill out the form accurately and efficiently.

1. Click the ‘Get Form’ button to retrieve the form and access it in your online editor.
2. Begin by entering the name of the client in the designated field, ensuring to use printed letters for clarity.
3. Input the client's social security number in the corresponding field, as this information is necessary for identification.
4. Enter the client's date of birth in the specified format, verifying that all entries are accurate.
5. Provide the client's CID if applicable, to further assist with identification within the system.
6. Authorize the Center for Mental Health in Aurora to share information by writing the name of the individual or organization with whom the information will be shared.
7. Enter the contact phone number for the person or organization in the field provided.
8. Provide the complete address, including city, state, and zip code, to ensure proper delivery of information.
9. Fill in the fax number of the individual or organization where the information will be sent, if available.
10. Select the types of information to be revealed by checking the appropriate boxes, including evaluations, medication histories, treatment plans, and more.
11. Indicate the dates of the information to be shared by checking 'All treatment dates' or providing specific dates in the fields provided.
12. Specify the purpose of this authorization by checking the appropriate option, such as 'Continuity of treatment' or any other relevant reason.
13. Read the acknowledgment of understanding the implications of sharing sensitive information and check that you agree.
14. Sign and date the form in the designated areas to validate the authorization provided.
15. If applicable, enter the name and contact information of the legal representative, and specify their relationship.
16. If you wish to revoke the authorization, complete the revocation section and sign again, ensuring the date is entered.
17. Once all fields are accurately completed, save your changes, download the form, or print it as needed for your records.

Complete your forms online to ensure a smooth and efficient process.