THE FOLLOWING FORMS ARE AVAILABLE FOR DOWNLOAD
RELEASE OF INFORMATION (ROI) - Written permission required for your counselor to communicate with another provider or any other person, regarding your care.
If you would like me to coordinate care with another provider (for example,
your psychiatrist, primary care physician, etc.), or if you would like to
give me permission to speak with someone regarding your care, please
complete this RELEASE OF INFORMATION form:
file:///C:/Users/Nikki/Documents/Counselor%20Forms/CARE%20Alliance%20Release%20of%20Information%20HIPAA-HIV-CD%20Compliant%20REV%2012-15.pdf
Other forms that may be benefical :
If you been referred to counseling or treatment services as part of a SAP or
employer referred evaluation or are otherwise required to participate in
self help groups as part of your treatment, you will need to have a the
chairperson of each self help group sign the attached
SELF HELP GROUP ATTENDANCE VERIFICATION
file:///C:/Users/Nikki/Documents/Counselor%20Forms/CARE%20Alliance%20Self%20Help%20Group%20Attendance%20Verification%20Slip%20REV%2012-15.pdf
Note: To download Adobe Acrobat Reader for free,
click here .
