Form LIC 605A. Release Of Client/Resident Medical Information
LIC 605A is a form used to release client/resident medical information by the California Department of Social Services, Community Care Licensing. The primary purpose of this form is to obtain consent from the client or their authorized representative to release their medical information to specified individuals or entities.
The form consists of several sections, including the client's name, date of birth, and identifying information. It also includes a section for the client or their authorized representative to provide information on the type of information being released, the person or entity receiving the information, and the purpose of the release.
Important fields include the client's signature or their authorized representative's signature, as well as the date the form was signed. It is important to note that all information provided in the form must be accurate and up to date.
There are no additional documents required to be attached while submitting Form LIC 605A. However, it is recommended to attach a copy of the client's identification document to verify their identity.
This form is typically required when the client wishes to authorize the release of their medical information to a specific person or entity, such as doctors or healthcare providers. This form is essential to ensure that only authorized individuals have access to the client's medical information.
Strengths of the form include its ability to protect client confidentiality and privacy. Weaknesses may include the potential for unauthorized parties to gain access to the client's information if the form is not completed correctly. Opportunities include the potential for improved communication between healthcare providers, while threats may include the misuse of client information by unauthorized parties.
Alternative forms that may be related to LIC 605A include the HIPAA Authorization Form and the Medical Records Release Form. However, these forms may cover different types of medical information or be used for different purposes.
The completion of this form affects the future of both the client and the authorized recipient of the medical information. Accurate information provided on this form can help ensure that the right individuals have access to the client's medical information to provide appropriate care.
The completed form can be submitted either online or in-person to the concerned authority. The information provided in the form is stored securely by the California Department of Social Services and is accessible only to authorized personnel.