The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Release Of Information Form In Contra Costa
Category:
State:
Multi-State
County:
Contra Costa
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.
To do this, you file a petition with the court and publish a notice in a newspaper. Then, you'll either have a court date (a hearing) where a judge will make a decision, or the judge may make a decision without a hearing. Once the judge decides, you pick up a court decree (court order) with your new name.
Make sure you have to show up at the hearing In some courts, the judge may order the change of name without a hearing as long as you followed all the steps required. If you forgot to ask the clerk about the hearing when you filed your papers, call the clerk's office now to make sure you have to show up.
Change your legal name Once the judge decides, you pick up a court decree (court order) with your new name. The process generally takes up to 3 months. Choose any part of the process below to get step-by-step instructions.
CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.
1-877-661-6230 Call if you have a medical problem or if you have a medical question.
Tzvieli, Ori. Dr. Tzvieli has been the County's health officer and Public Health Director since Sept. 2021.
Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24-Hour Nurse Advice Line at 1-877-661-6230 (Option 1).
The Contra Costa County Vital Registration Office is able to provide certified copies for births occurring this year and last year in Contra Costa County. Births that occurred prior to that may be obtained from the Clerk-Recorders Office at 925-335-7900 or on the County Clerk website.
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By filling out the form below, you give the County of Contra Costa ("County") the absolute right and permission to the unlimited use of your image and likeness. Services and Programs " Behavioral Health " Member Services - Behavioral Health " Medical Health Records.Release of Information (ROI). Students may choose to complete and submit this form to the Registrar allowing the release of their education records to specified third parties. The Clerk-Recorder's Office does not offer blank forms of documents for recording. Clerk-Recorder Staff is prohibited from giving legal advice. Release of Information: This form will allow your clinician to speak with other providers or concerned parties which you designate. Use this form to request a check from a Foundation Program Account. Please fill out and print form, and attach supporting documentation. Recording Requirements.
