Authorization To Release Health And Mental Health Information {JV-226}

JV-226, Authorization to Release Health and Mental Health Information (Dependency), this form is used by a parent or legal guardian to authorize the release of the child’s health and/or mental health records to the child welfare agency to make sure that the child receives good services. This form authorizes the release of the child’s health and/or mental health records to the child welfare agency to ensure that the child receives appropriate and effective services. It also allows the agency to carry out its case management responsibilities; to monitor treatment, health-care operations, and billing and payment; and to inform the court of the child’s medical and/or mental health needs. This form complies with the Health Insurance Portability and Accountability Act (HIPAA), Confidentiality of Medical Information Act (CMIA), and Lanterman-Petris-Short (LPS) Act. Judicial Council of California, Revised July 1, 2013, Optional Form. www.FormsWorkflow.com