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.
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Samples: www.nancyholmespsyd.com, www.nancyholmespsyd.com, www.nancyholmespsyd.com
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: marciajwoodphd.com, www.familyinstitute.net
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 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.
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Samples: static1.squarespace.com