The Mental Health Release Form serves as a critical tool in managing the confidential transfer of mental health information while maintaining compliance with U.S. privacy laws. This document becomes necessary when mental health records need to be shared between providers, with insurance companies, or with other authorized parties. It ensures that sensitive information is handled appropriately and that patient privacy rights are protected under HIPAA and state regulations. The form typically includes patient identification, specific information to be released, intended recipients, purpose of disclosure, and duration of authorization.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Patient Information: Full legal name, date of birth, contact information, and any relevant identification numbers
2. Provider Information: Healthcare provider or facility details, including name, address, and contact information
3. Information to be Released: Specific description of what mental health information is authorized for release
4. Purpose of Release: Clear statement of why the information is being released
5. Duration: Expiration date or event for the authorization
6. Rights Statement: Patient's rights regarding revoking authorization and any limitations
1. Specific Exclusions: List of information specifically excluded from release, used when patient wants to restrict certain information
2. Electronic Records Authorization: Specific authorization for electronic records, used when records will be transmitted electronically
3. Research Authorization: Additional permissions for research purposes, used when information may be used in studies
1. List of Authorized Recipients: Detailed list of individuals or organizations authorized to receive information
2. Specific Records Checklist: Itemized list of specific records authorized for release
Relevant legal definitions
Clauses
Relevant Industries
Relevant Teams
Relevant Roles
Find the exact document you need
Military Medical Record Request Form
U.S. legal document for requesting military medical records in compliance with federal privacy laws.
Download
Employment Background Check Release Form
A U.S. legal document authorizing employers to conduct background checks on job candidates while ensuring compliance with federal and state regulations.
Download
Phi Consent Form
A U.S. HIPAA-compliant authorization form for the use and disclosure of protected health information.
Download
Phi Authorization Form
A U.S. HIPAA-compliant form authorizing the disclosure of protected health information to specified recipients.
Download
Dr Work Release Form
A U.S. compliant medical document authorizing an employee's return to work with specified conditions and restrictions.
Download
Police Vehicle Release Form
A U.S. legal document authorizing the release of an impounded vehicle from police custody to its rightful owner or representative.
Download
Authorization For Release Of Protected Health Information Phi
A U.S. HIPAA-compliant authorization form permitting the release of protected health information between specified parties.
Download
Form For Requesting Medical Records
A HIPAA-compliant form used in the US for requesting personal medical records from healthcare providers.
Download
Share Medical Information Form
A HIPAA-compliant authorization form used in the United States for sharing protected health information between specified parties.
Download
Release Of Records Request Form
A U.S.-compliant form used to request and authorize the release of records from organizations or institutions.
Download
Release Of Information Statement
A U.S. legal document authorizing the controlled disclosure of confidential information between specified parties.
Download
Release Form From Police Department
A U.S. legal document authorizing police departments to release official records while ensuring compliance with federal and state privacy laws.
Download
Printable Work Release Form
A U.S. legal document authorizing an employee's return to work following medical leave, including any necessary work restrictions or accommodations.
Download
Military Dependent Medical Records Request Form
A U.S. military healthcare system form for requesting medical records of military dependents, compliant with federal privacy regulations.
Download
Medical Records Pick Up Form
A U.S.-compliant form authorizing the release and pick-up of medical records, ensuring HIPAA compliance and patient privacy protection.
Download
Letter For Medical Records Request
A HIPAA-compliant formal request for medical records under U.S. federal and state laws.
Download
Generic Dental Records Release Form
A HIPAA-compliant U.S. form authorizing the release of dental records from provider to patient or designated recipient.
Download
Employee Photo Consent Form Gdpr
A dual-jurisdiction (US/EU) consent form for employee photo usage that complies with GDPR and US privacy requirements.
Download
Dental Release Of Information Form
A U.S.-compliant legal document authorizing the release of dental records from a provider to specified recipients while maintaining HIPAA compliance.
Download
CT Medical Records Release Form
A HIPAA-compliant authorization form used in the U.S. to permit the release of medical records to designated recipients.
Download
Consent For Use And Disclosure Of Health Information Form
A U.S. HIPAA-compliant authorization form allowing healthcare providers to use and share protected health information.
Download
Authorization To Release Rental History
A U.S. legal document authorizing the release of tenant rental history information while complying with federal and state privacy laws.
Download
Authorization To Release Credit Information Form
A U.S. legal document granting permission to access an individual's credit report and financial information, compliant with FCRA and state privacy laws.
Download
Authorization To Disclose Medical Information Form
A U.S. HIPAA-compliant form authorizing the release of specified medical information to designated recipients.
Download
Authorization Release Form For Background Check
A U.S. legal document authorizing employers to conduct background checks on potential or current employees in compliance with federal and state regulations.
Download
Athletic Medical Release Form
A U.S. legal form authorizing emergency medical treatment for athletes and providing liability protection for healthcare providers and athletic organizations.
Download
Minor Medical Treatment Authorization Form
A U.S. legal document authorizing medical treatment for minors when parents/guardians are not present.
Download
Medical Consent Form For Temporary Guardian
A U.S. legal document authorizing a temporary guardian to make medical decisions for a minor when the primary guardian is unavailable.
Download
Authorization For Release
A U.S. legal document granting permission to share specified information between parties, compliant with federal and state privacy laws.
Download
Written Authorization To Release Information
A U.S.-compliant legal document authorizing the release of specific personal information between designated parties.
Download
Workers Comp Medical Release Form
A U.S. legal document authorizing the release of medical information for workers' compensation claims processing.
Download
Work Release Form Hospital
A U.S. legal document providing medical clearance for employees to return to work, including any necessary restrictions or accommodations.
Download
Veterinary Medical Release Form
A U.S. legal document authorizing veterinary professionals to provide medical treatment to an animal in the owner's absence.
Download
Universal Medical Release Form
A HIPAA-compliant authorization form used in the United States for releasing medical records to specified parties.
Download
Service Release Form
A U.S.-compliant legal document that confirms service completion and releases parties from related future claims or obligations.
Download
Revocation Of Release Of Information Form
A U.S. legal document used to withdraw previous authorization for sharing personal information, compliant with federal and state privacy laws.
Download
Release Form For Video Recording
A U.S. legal document granting permission to record and use an individual's image and likeness in video content.
Download
Records Request Form Medical
A U.S.-compliant form used to request and authorize the release of medical records under HIPAA regulations.
Download
Public Adjuster Release Form
A U.S. legal document that releases a public adjuster from further obligations upon completion of insurance claim services and receipt of payment.
Download
Physician Medical Release Form
A U.S. legal document authorizing healthcare providers to release patient medical information in compliance with HIPAA regulations.
Download
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)