• A Better Way Counseling Service, LLC

    General Release of Information
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  • I authorize the below parties to exchange the following information with A Better Way Counseling Service:



  • 2. Domestic Violence Treatment Program Manager and Washington State Department of Social and Health Services with Community Services Division

     

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  • This release is valid for one year after completion or termination of designated treatment. A patient may revoke in writing a disclosure authorization to a health care provider at any time unless disclosure is required to effectuate payments for health care that has been provided or other substantial action has been taken in reliance on the authorization. A patient may not maintain an action against the health care provider for disclosures made in good-faith reliance on an authorization if the health care provider had no actual notice of the revocation of the authorization. In compliance with WAC 110-60A we will have to consider if the release is required for continuing your treatment program. If a required release is revoked we may terminate you from our program. This release covers information being released to Washington State Department of Social and Health Services.

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