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Division/Section Family Support (ES) Chapter No./Name Economic Stability (ES) Part No./Name B-Eligibility Factors (FITAP) Section No./Name B-1800 Drug Testing (FITAP) Document No./Name B-1830-FITAP Consent for Release of Information Effective Date February 1, 2013

1 of 1 I. STATEMENT OF POLICY

Prior to referral to OBH, have each recipient being referred sign the following Consent for Release of Information forms:

● Consent for release of information by the Department of Children and Family Services to OBH.

● Consent for release of information by OBH to the Department of Children and Family Services.

II. PROCEDURES

Use the * Form DCFS 35 and DCFS 35H ** for these releases. Complete the release forms after the initial ES screening is completed and referral to OBH is indicated or prior to making a referral based on reasonable cause. The client’s failure to sign either of the release forms constitutes a failure to participate (Refer to B-1870-FITAP-Failure to Satisfactorily Participate).

Each release form must contain a specific expiration date agreed to by the client. The release may be revoked by the client before the expiration date. The expiration date should not exceed 12 months from the date the release is completed. If a client remains in a treatment/rehabilitation program at the time the releases expire, OBH will execute two new releases.

Any break in FITAP eligibility of the recipient referred to OBH will result in the automatic termination of both releases. A break in eligibility is defined as the loss of cash eligibility for one or more months, with the exception of those cases which do not receive a cash benefit wholly due to the minimum $10 grant. Subsequent referrals to OBH will require the completion of two new releases.

III. FORMS AND INSTRUCTIONS

* DCFS 35 Form/Instructions - Consent to Release Information (Other than Protected Health Information) Waiver of Confidentiality Form

DCFS 35H Form/Instructions - Authorization to Release Protected Health Information

IV. REFERENCES

LAC 67:III.1249

R.S. 46:460.10 **