Collaborative Courts Mental Health And Medical ROI {SUPCR-1134}

SUPCR 1134 - AUTHORIZATION FOR USE, EXCHANGE, AND/OR DISCHARGE OF CONFIDENTIAL MENTAL HEALTH AND MEDICAL INFORMATION FOR ENTRY AND PARTICIPATION IN THE COLLABORATIVE COURTS. This form is used for authorizing the Superior Court of California, County of Santa Cruz. The purpose of this disclosure is to assess and determine the appropriate treatment, progress, and compliance with the Collaborative Courts. The form includes consent for the release of information to specific agencies such as the Santa Cruz County Department of Probation, District Attorney, Public Defender, Department of Veterans Affairs, Health Services Agency, Sheriff’s Department, and others involved in the Collaborative Courts program. The authorization remains in effect until the client's participation in Collaborative Court is terminated or completed, unless a written request to cancel or change the authorization is submitted. Form Adopted for INTERNAL USE. www.FormsWorkflow.com