Release of Information Forms & Information

These sample authorization forms were developed to contain the core elements required by the Federal Privacy Rule, as well as content considered most useful to Oregon psychologists.  They have been reviewed by OPA’s attorney, Paul Cooney, and are compliant with federal and state law as of March 2011.  Please review the "Comments and Information" sheet before using these forms in your practice.

Comments and Information Regarding Use of the Forms - click here

 

Adult Release of Information Form 

click here for the form in PDF

click here for the form in Word


Child Release of Information Form

click here for the form in PDF

click here for the form in Word