Uniform release of information forms

A person can grant written permission to release his or her health information, which facilitates information sharing. Jurisdictions may obtain an authorization or consent form at various stages of the criminal justice process, such as at initial contact with law enforcement, at jail booking, or when joining a mental health court or other diversion program. The forms that jurisdictions use vary and can cover multiple purposes and parties.

For samples related to this intervention, see these resources:

• Michigan Behavioral Health Standard Consent Form
• Informed Consent Release Form - Salt Lake City, UT
• Authorization for Release of Information - Portland, ME

Local Examples

Douglas County, KS Assist-Identify-Divert Multi-Service Team

• The Assess-Identify-Divert Team in the Douglas County Jail developed a multi-agency consent form for the release of confidential information.
• People can choose whether to authorize the release of their confidential information to multiple agencies using one form.

For a sample related to this example, see this resource:

• Multi-Agency Consent for the Release of Confidential Information - Douglas County, KS

Winona County, MN Reentry Assistance Program Plus

• Winona County’s Reentry Assistance Program Plus (WRAP+) provides a consent and release of information form for potential participants on its website. This form allows for information sharing across a variety of services and systems.