The California MH 5671 form serves as an authorization for the release of confidential patient information related to mental health services. It is designed to ensure that patients can control who accesses their mental health records. By completing this form, patients or their guardians can provide consent for specific information to be shared with designated individuals or organizations. This process is crucial for maintaining the privacy and confidentiality of sensitive health information.
The form must be signed by the patient or, if the patient is unable to provide consent, by a parent, guardian, or conservator. If the patient signs the form, a witness signature is also required. This ensures that the authorization is valid and that the patient is fully aware of the information being released. It's important to note that the patient has the right to refuse to sign the authorization, and if they do, the information cannot be released unless required by law.
The MH 5671 form allows for the release of various types of mental health information. Some of the categories that can be specified include:
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Entire Record
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Diagnosis
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Psychiatric Evaluation
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Discharge Summary
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Social History
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Individual Treatment Plan
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Legal Information
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Medical and Neurological Assessments
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Results of Psychological or Vocational Testing
Patients can choose specific items to be released, allowing them to control the flow of their personal health information.
How long is the authorization valid?
The authorization provided through the MH 5671 form remains valid for a specific duration, which can be selected by the patient or their representative. Options typically include a duration of six months, one year, or a specified date. If the authorization is not revoked, it will automatically terminate at the end of the chosen period. Patients should be aware that they can revoke the authorization at any time in writing, except where actions have already been taken based on the authorization.
Patients have several rights concerning their information when using the MH 5671 form. They can:
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Inspect or obtain a copy of the protected health information that is to be disclosed.
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Refuse to sign the authorization, which prevents the release of their information unless legally required.
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Request a revocation of the authorization at any time, ensuring they maintain control over their personal health information.
These rights empower patients and help safeguard their mental health records.