Authorization To Release Health Records And Information {RLMHD}

RLMHD - AUTHORIZATION TO RELEASE HEALTH RECORDS AND INFORMATION. This form is used by the Superior Court of California, County of San Mateo, to obtain a defendant’s consent to release mental health records and related information for the purpose of determining eligibility for the Mental Health Diversion program. By signing the form, the defendant authorizes their treatment provider to share records with the District Attorney, Defense Attorney, the Court, and members of the Multi-Disciplinary Team (MDT) handling their case. The form also documents the defendant’s understanding that aspects of their mental health and treatment may be discussed in open court, that ongoing compliance reports will be submitted to the Court, and that failure to comply with the treatment plan could result in termination from the program. It further explains limitations on how mental health information may be used in other proceedings and that the authorization remains in effect for the duration of participation in Mental Health Diversion unless revoked, in which case the Court will determine if participation can continue. www.FormsWorkflow.com