Consent for Release - Details 1 Tab

Click here to return to the Consent for Release table of contents

1. Release Name- Enter a name for the Consent for Release (i.e. Social Services Consent for Release).
   
   
    
2. Between Name- Enter an Agency Name you wish to send the consent to (i.e. Agency X).
   
   
    
3. Select to send the consents to a person or other organization(s) in the Agency.
   • Use Name/Relationship- Select to send the consent to a person in the Agency.
     • By selecting this field, the other organizations information is grayed out.
       
       
        
   • Use Other Organizations- Select to send the consent to another organization(s).
     • Select an existing Other Organization by clicking Enter and choosing one from the list.
     • This will prefill the address and a contact name if it was included in the set up under Administration 🡪 Other Organizations).
     • If you are creating a new Other Organization enter the Name, Address, and Contact Name (If desired).
     • To use a specific contact at the Other Organization, flag the box next to Use Contact.

       NOTE: You can leave this blank and this organization information can be completed at the time the release is completed by the client.

     • 
4. For Use on SA013_ROI- Used specifically for the SA013_ROI form, specific to New York State.
   
   
   
   
    

[Back to Top]