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Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) - Spanish

State:
Missouri
Control #:
MO-SKU-0417
Format:
PDF
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Description

Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) - Spanish Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish is a document that enables a person to release confidential information regarding drug or alcohol abuse programs. This form is used in cases where an individual or entity is seeking to obtain information about a person’s participation in or treatment for a drug or alcohol abuse program. The form enables the release of confidential information from the program to the requesting party. The Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish form is available in two versions: a short form and a long form. The short form is used to release information about the participant's current treatment; the long form provides additional information about the participant's past treatment and participation. The form must be completed and submitted to the program in order to obtain the requested information. The Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish form must be completed in Spanish, and includes the participant's personal information, the purpose of the request, the type of information to be released, and the signature of both the participant and a witness. The form must be completed and submitted to the program in order to obtain the requested information. Keywords: Missouri Authorization to Release Confidential Information, Drug or Alcohol Abuse Programs, Spanish, Short Form, Long Form, Treatment, Past Treatment, Participant, Signature, Witness.

Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish is a document that enables a person to release confidential information regarding drug or alcohol abuse programs. This form is used in cases where an individual or entity is seeking to obtain information about a person’s participation in or treatment for a drug or alcohol abuse program. The form enables the release of confidential information from the program to the requesting party. The Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish form is available in two versions: a short form and a long form. The short form is used to release information about the participant's current treatment; the long form provides additional information about the participant's past treatment and participation. The form must be completed and submitted to the program in order to obtain the requested information. The Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) — Spanish form must be completed in Spanish, and includes the participant's personal information, the purpose of the request, the type of information to be released, and the signature of both the participant and a witness. The form must be completed and submitted to the program in order to obtain the requested information. Keywords: Missouri Authorization to Release Confidential Information, Drug or Alcohol Abuse Programs, Spanish, Short Form, Long Form, Treatment, Past Treatment, Participant, Signature, Witness.

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Missouri Authorization to Release Confidential Information (Drug or Alcohol Abuse Programs) - Spanish