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Image of the outline of New York State. Consent and Authorization (TRS) Consent to Release General Information to Family TRS-3 TRS-3 Consent to disclose information concerning substance use disorder, patient's presence in facility, and general medical condition to friends or relatives. Multiple languages available. Learn more about Consent to Release General Information to Family TRS-3
Image of the outline of New York State. Consent and Authorization (TRS) Release Information to Criminal Justice Agencies TRS-4 TRS-4 Irrevocable consent to communicate with criminal justice agencies/persons. Multiple languages available. Learn more about Release Information to Criminal Justice Agencies TRS-4
Image of the outline of New York State. Consent and Authorization (TRS) Authorization for Release of HIV-Related Information TRS-5 TRS-5 Consent to Disclose confidential HIV/AIDS Information. Multiple languages available. Learn more about Authorization for Release of HIV-Related Information TRS-5
Image of the outline of New York State. Consent and Authorization (TRS) Consent to Disclose Communicable Diseases TRS-7 TRS-7 Consent for the disclosure of communicable diseases including COVID-19 to the New York State Department of Health. Multiple languages available. Learn more about Consent to Disclose Communicable Diseases TRS-7
Image of the outline of New York State. Consent and Authorization (TRS) Confidentiality Notice TRS-8 TRS-8 Informs Patients How Their Confidential Information Will be Handled. Multiple languages available. Learn more about Confidentiality Notice TRS-8
Image of the outline of New York State. Consent and Authorization (TRS) Consent to Enter Inpatient Treatment as a Minor TRS-9 TRS-9 Consent form signed by a Parent/Guardian for persons under the age of 18. Multiple languages available. Learn more about Consent to Enter Inpatient Treatment as a Minor TRS-9
Image of a report. Consent and Authorization (TRS) Physician Certification (TRS-18) Physician certification required for inpatient substance use disorder services. Download about Physician Certification (TRS-18)
Image of the outline of New York State. Consent and Authorization (TRS) Request for Copy of Clinical Records TRS-28 TRS-28 Used by patients requesting a copy of their clinical record. Multiple languages available. Learn more about Request for Copy of Clinical Records TRS-28
Image of the outline of New York State. Consent and Authorization (TRS) Request to Amend Patients Records TRS-32 TRS-32 To be used by a patient requesting an amendment of their clinical record. Multiple languages available. Learn more about Request to Amend Patients Records TRS-32
Image of the outline of New York State. Consent and Authorization (TRS) Request to Restrict Use TRS-35 TRS-35 To be used by patients who wish to to restrict the disclosure of their confidential information. Multiple languages available. Learn more about Request to Restrict Use TRS-35
