Workers’ Compensation Claim. If you file a Worker’s Compensation Claim, this constitutes authorization for me to release your relevant mental health records to involved parties and officials. This would include a past history of complaints or treatment of a condition similar to that involved in the Worker’s Compensation Claim.
Appears in 4 contracts
Samples: Treatment Agreement, Treatment Agreement, Treatment Agreement
Workers’ Compensation Claim. If you file a Worker’s Compensation Claimclaim, this constitutes authorization for me to release your relevant mental health records to involved parties and officials. This would include a past history of complaints or treatment of a condition similar to that involved in the Worker’s Compensation Claim.
Appears in 2 contracts
Samples: Informed Consent Agreement, Informed Consent Agreement
Workers’ Compensation Claim. If you file a Worker’s Compensation Claimclaim, this constitutes authorization for me to release your relevant mental health records to involved parties and officials. This would include a past history of complaints or treatment of a condition similar to that involved in the Workerworker’s Compensation Claimcompensation claim.
Appears in 2 contracts
Samples: Agreement and Informed Consent for Treatment, Treatment Agreement
Workers’ Compensation Claim. If you file a Worker’s Compensation Claim, this constitutes authorization for me your therapist to release your relevant mental health records to involved parties and officials. This would include a past history of complaints or treatment of a condition similar to that involved in the Workerworker’s Compensation Claimcompensation claim.
Appears in 1 contract
