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Consent and Authorization (TRS)

Sample of Authorization for Access to Patient Information Plan of...

TRS-65 Sample consent from authorizing limited consent for sharing a Plan of Safe Care only. Multiple languages available.

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Consent and Authorization (TRS)

Telepractice Informed Consent TRS-66

TRS-66 Patient's consent to receive substance use disorder services via telepractice. Multiple languages available.

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Consent and Authorization (TRS), Reporting (PAS)

Consent to Release Personal Information PAS-101L

PAS-101L Consent to release information concerning treatment history for the purposes of obtaining insurance benefits. Multiple languages available.

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Consent and Authorization (TRS), Regulatory Compliance (QA, TA, SQA)

Gambling Release of Information TAG-11

TAG-11 Consent for Release of Information for problem gambling treatment patients. Multiple languages available.

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Consent and Authorization (TRS), Impaired Driver Services (IDSM)

Impaired Driver Consent Form IDSM-3

IDSM-3 Providers must obtain consent from the motorist in order to access their records in the Impaired Driver System,

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Consent and Authorization (TRS), Impaired Driver Services (IDSM)

Probation Department Access IDSM-8

IDSM-8 A form filled out by the individual to authorize access by the Probation Department to Impaired Driver System data pertaining to all relevant aspects of the motorist’s impaired driver offense...

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Certification (PPD)

Other Changes - Certification Instructions

Instructions for Other Changes to Existing Facility/Agency includes Capacity Increase, Capital Project, Changes to Prevention, Add/Remove Apartments, Minor Relocation, New Treatment Service, Additional Location, Relocation...