BHRS Authorization and Consent Forms
CLINICAL CONSENT FORMS
AVATAR CLINICAL CONSENT FORM GUIDE AND SCRIPTS
Translations:
AVATAR PAPER CONSENT TRACKING
CONSENTS RELATED TO TREATMENT
- Consent to Treatment & Acknowledgement of Receipt of Privacy Practices and Notice of Privacy Practices
- Consent to Electronic Communication
- Notice of License
Miscellaneous Consents Related to Treatment
MEDICATION CONSENT FORMS
AVATAR MEDICATION CONSENT FORM GUIDE AND SCRIPTS
- Avatar Medication Form Scripts for Clinicians
Translations Chinese Medication Script Spanish Medication Script Russian Medication Script Tagalog Medication Script Tongan Medication Script
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
- Staff Request to Block BHRS Electronic Medical Record
Miscellaneous Consents Related to Protecting PHI
- Senior Peer Counselor:
- Student Observation at Behavioral Health Clinic
- Media Release Form (SMC Employee, Contractor, Client or Volunteer)
- Session Recording and 1-Way Mirror Observation: English Spanish