10A NCAC 26B .0202 CONSENT FOR RELEASE form
(a) When consent for release of information is obtained by an area or state facility covered by the rules in this Subchapter, a Consent for Release form containing the information set out in this Paragraph shall be utilized. The consent form shall contain the following information:
(1) client's name;
(2) name of facility releasing the information;
(3) name of individual or individuals, agency or agencies to whom information is being released;
(4) information to be released;
(5) purpose for the release;
(6) length of time consent is valid;
(7) a statement that the consent is subject to revocation at any time except to the extent that action has been taken in reliance on the consent;
(8) signature of the client or the client's legally responsible person; and
(9) date consent is signed.
(b) Unless revoked sooner by the client or the client's legally responsible person, a consent for release of information shall be valid for a period not to exceed one year except under the following conditions:
(1) a consent to continue established financial benefits shall be considered valid until cessation of benefits; or
(2) a consent for release of information to the Division, Division of Motor Vehicles, the Court and the Department of Correction for information needed in order to reinstate a client's driving privilege shall be considered valid until reinstatement of the client's driving privilege.
(c) A consent for release of information received from an individual or agency not covered by the rules in this Subchapter does not have to be on the form utilized by area or state facilities; however, the receiving area or state facility shall determine that the content of the consent form substantially conforms to the requirements set forth in this Rule.
(d) A clear and legible photocopy of a consent for release of information shall be considered to be as valid as the original.
(e) Confidential information relative to a client with HIV infection, AIDS or AIDS related conditions shall only be released in accordance with G.S. 130A‑143. Whenever authorization is required for the release of this information, the consent shall specify that the information to be released includes information relative to HIV infection, AIDS or AIDS related conditions.
History Note: Authority G.S. 122C‑52; 122C‑53; 130A‑143; 131E‑67; 143B‑147;
Eff. July 1, 1979;
Amended Eff. July 1, 1993; February 1, 1991; March 1, 1990; February 1, 1986;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 20, 2015.