New Jersey Waiver, Release and Authorization to Use a Description of Patientýs Psychological History and Treatment in a Book without Identifying the Name of Patient

State:
Multi-State
Control #:
US-04321BG
Format:
Word; 
Rich Text
Instant download

Description

A release gives up a right, such as releasing one from his/her liability for harm or damage that may occur from performing under a contract, or participating in an activity. A release acts as some assurance to the person requesting the release that he/she will not be subjected to litigation resulting from the person giving the release. The term waiver is sometimes used to refer a document that is signed before any damages actually occur. A release is sometimes used to refer a document that is executed after an injury has occurred.


This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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FAQ

A valid authorization for release of information must include the patient’s name, specific information to be released, the purpose of the release, and the dates applicable. Additionally, the New Jersey Waiver, Release and Authorization to Use a Description of Patient’s Psychological History and Treatment in a Book without Identifying the Name of Patient may be included to clarify context. Remember to include a signature from the patient or legal representative, along with the date.

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New Jersey Waiver, Release and Authorization to Use a Description of Patientýs Psychological History and Treatment in a Book without Identifying the Name of Patient