Get Northwestern University The Family Institute Consent For Release Of Information 2020-2025

Filling out the Northwestern University The Family Institute Consent For Release Of Information form online is an essential step in managing your mental health records. This guide will provide you with detailed instructions to help you navigate each section of the form with confidence.

Follow the steps to accurately complete your consent form.

1. Click ‘Get Form’ button to obtain the consent form and open it for editing.
2. Enter the client’s name in the appropriate field. This should be the individual whose information will be released.
3. Fill in the client's date of birth to identify the correct client. This is crucial for personal identification.
4. Provide the client's email address and phone number to facilitate communication and follow-ups.
5. Authorize The Family Institute to release information by entering the name of the person or organization to whom the information will be released.
6. Specify the relationship of the authorized person to the client to ensure that the recipient has a valid reason for receiving the information.
7. Complete the address, including city, state, and zip code, of the individual or organization receiving the information.
8. Indicate the dates for which information will be released by filling in the date range.
9. Select one or more categories of information to be shared, such as clinician summary, treatment notes, or report of progress.
10. Specify the purpose for releasing the information. This includes options like ongoing care, treatment planning, or any legal and insurance needs.
11. If applicable, specifically note if drug and alcohol use information is being shared, ensuring separate consent.
12. Indicate which clinicians are involved by noting Clinician A and Clinician B if necessary.
13. Complete the consent expiration date. If no date is provided, it will remain valid only on the date received.
14. Ensure the client (if aged 12 or older) signs the form. If the client is under 18 or adjudicated incompetent, a parent or guardian’s signature is required.
15. If applicable, include the signature of another parent in cases of separation or divorce.
16. Sign and date the witness field to validate the consent.
17. Once all information is complete, save changes to the document. You can choose to download, print, or share the form as necessary.

Complete your documents online with confidence by following these user-friendly steps.