BHRS Authorization and Consent Forms
AVATAR CLINICAL CONSENT FORMS
- Advances Health Care Directives
- Assignments of Benefits
- Consent to Electronic Communication
- Consent to Treatment & Acknowledgement of Receipt of Privacy Practices
- Notice of License
RELEASE OF PROTECTED HEALTH INFORMATION (PHI)
- Authorization for Use or Disclosure of PHI
- Client Access to PHI
- Amendment of PHI – Client Request
- Restrictions on Use or Disclosure of PHI – Client Request
- Media Release Form (SMC Employee, Contractor, Client or Volunteer)
- Staff Request to Block BHRS Electronic Medical Record
MEDICATION CONSENT FORMS
AVATAR GUIDES, SCRIPTS & FAQs
AVATAR CLINICAL CONSENT FORM GUIDE AND SCRIPTS
AVATAR MEDICATION CONSENT FORM GUIDE AND SCRIPTS
AVATAR HOW TO GUIDES & FAQ
OTHER CLINICAL FORMS
- Change of Provider Request
- Senior Peer Counselor:
- Session Recording and 1-Way Mirror Observation: English Spanish
- Student Observation at Behavioral Health Clinic
- Urine Toxicology Screening Agreement
- Youth Emergency/Medication Consent Release Form