INFORMATION INCLUDES, BUT IS NOT LIMITED TO:
Diagnosis, prognosis, or treatment data; initial interview, treatment summaries, discharge summary, psychological assessment; or other information.
I understand that my records are protected under federal and Massachusetts laws and cannot be disclosed without my written consent except as otherwise specified by these laws. Furthermore, I understand that if my records involve alcohol or drug abuse they are also prohibited under the Federal Reg. 42CFR, confidentiality of alcohol and drug abuse.
I have carefully read and understand the above statements and do herein consent to disclose the above information, including alcohol and drug abuse records, if relevant, to those persons/agencies named above.
I further release Norwood Behavioral Health from any liability arising from the release of this information to such persons/agencies, provided that said release of information is done substantially in accordance with applicable laws. I understand that I may revoke my consent at any time. This revocation will only affect future disclosure or release of information.