Get Ca Substance Abuse Prevention And Control Release Of Information - County Of Los Angeles 2021-2025

Filling out the CA Substance Abuse Prevention And Control Release Of Information form online is a crucial step in managing your healthcare and ensuring effective communication between your healthcare providers. This guide provides clear and comprehensive instructions to help you complete the form with confidence.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the online form, allowing you to open and complete it in the editor.
2. Enter your personal details in the Patient Information section, including your name, date of birth, address, Medi-Cal or My Health LA number, and phone number.
3. In the Entities Who May Share Health Information section, select either Option 1 to authorize all providers within the SAPC Provider Network or Option 2 to specify certain providers by listing their names.
4. Navigate to the Scope of Disclosure section and indicate the types of information you permit to be shared by checking the relevant boxes for items such as drug test results or treatment plans.
5. Fill in the expiration date for your authorization in the Expiration of Authorization section, specifying a date or indicating one year from the date of signing.
6. Review the important information provided in the Other Important Information section to ensure you understand your rights regarding your health information.
7. Sign and date the Signature of Patient or Legal Representative section, providing your printed name and relationship if applicable.
8. Complete the Revocation of Authorization section if you wish to revoke this consent in the future, and ensure to send it to the specified address.
9. Finally, save your changes, download a copy, print the completed form, or share it as needed.

Complete your documents online today for a smoother healthcare experience.