PROFESSIONALS: You are receiving this because your current patient is seeking group therapy treatment at Northwest ADHD Treatment Center, in addition to care provided by you. The purpose of this release is to enable professional communication to: coordinate care, ensure that group engagement at Northwest ADHD Treatment Center is consistent with your treatment plan, and affirm that you and your patient are aware that you are their primary mental health provider and any crises or urgent needs should be addressed through you. Please send any relevant records that may assist care coordination. Thank you.
PATIENTS: Northwest ADHD Treatment Center offers group therapy options as a means to support and enhance your current mental health treatment. In order to do this effectively, our providers need to coordinate care with your primary behavioral health provider. It is important that you are aware that your current behavioral health provider outside of Northwest ADHD Treatment Center is primarily responsible for your mental health care, including your overall treatment plan and any plans related to urgent mental health needs or crises. Please be sure you complete this form for your current behavioral health provider. If you do not have a current behavioral health provider, you may not be able to participate in group therapy at Northwest ADHD Treatment Center. If you would like us to receive records or communicate with other professionals, agencies, or individuals, please complete a separate version of this form.
AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION
For offices submitting records: Fax is the preferred means for NW ADHD to receive records.