Consent to Release – Boilerplate information

Don’t forget to customize the AASC Online Consent to Release form before giving it to a member/resident to sign!  Boilerplate information to use is below…

For AASC Online Textbox: “I authorize the SC at this facility to disclose the following information”, include:

Resident File

For AASC Online Textbox: “To the following person or organization”, include:

Other Service Coordination team members, including practice supervisor(s), substitute
service coordinators, intern(s), quality assurance reviewer(s), and HUD staff

For AASC Online Textbox: “The purpose of this disclosure is to”, include:

Provide for continuity and quality of service in a confidential manner