HIPAA Release Of Information Order {CN-530 ANCH}

CN-530 ANCH - CINA THERAPEUTIC COURT - HIPAA RELEASE OF INFORMATION ORDER. This form is used by the Superior Court of Alaska to authorize the limited release of confidential substance use disorder and behavioral health treatment records for a participant in the CINA (Child in Need of Aid) Therapeutic Court program. The form confirms that the participant has been accepted into the program and that, as a condition of participation, their progress in treatment must be monitored by the CTC Team. It verifies that the participant has voluntarily signed HIPAA- and 42 C.F.R. Part 2-compliant releases, allowing specific treatment-related information—such as assessments, diagnoses, drug testing results, attendance, compliance, and prognosis—to be shared with members of the CTC Team. The order permits the designated treatment provider to release only the minimum necessary information for up to twelve months or until the participant successfully completes or is terminated from the program. The form also emphasizes that this information must not be re-disclosed outside the CINA case team except as allowed by law. It is signed by a Superior Court Judge and includes a certification of distribution to involved parties and legal representatives. www.FormsWorkflow.com