Release of Information Form Sample Clauses

Release of Information Form. Since the treatment provider letter is maintained as part of your medical record in CAPS and/or UHS, a limited Release of Information Form is required in order for the Brown clinicians to participate fully in the clearance committee. Signing the release allows Xxxxx’x clinicians to share some information included in the support letter provided to us. The form is Xxxxx'x standard release and has been pre-completed to indicate that you give the CAPS and/or UHS staff who review your letter permission to share relevant information with the committee. This release does not apply to any information aside from the letter, and it does not give permission to share the contents of the letter with anyone outside of the committee. The form can be found in the medical leave section of the Student Support Services website and will also be provided to you as part of reminders about the clearance process. CLEARANCE REVIEW PROCESS
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Release of Information Form. Since the treatment provider letter is maintained as part of your medical record in CAPS and/or UHS, a limited release of information form is required in order for the Xxxxx clinicians to participate fully in the clearance committee. Signing the release allows Xxxxx’x clinicians to share some information included in the support letter provided to us. The form is Xxxxx'x standard release and has been pre-completed to indicate that you give the CAPS and/or UHS staff who review your letter permission to share relevant information with the committee. This release does not apply to any 1 See xxxxx://xxx.xxxxx.xxx/offices/student-support/meeting-xxxx/course-load-reductions. information aside from the letter, and it does not give permission to share the contents of the letter with anyone outside of the committee. The form can be found in the medical leave section of the Student Support Services website and will also be provided to you as part of reminders about the clearance process. CAS Documents
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Release of Information Form. If applicable, the provider shall ensure that the client signs a Release of Information form (Attachment IX) that authorizes the release of DHS SAVE data to ESS, RS, and the provider, and that explains when social security number disclosure is mandatory and when the disclosure is voluntary.
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Release of Information Form giving permission to appropriate eSchool staff to discuss progress and updates with the student’s referring health care provider.
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Release of Information Form. If you wish to have a family member, power of attorney, etc. discuss any aspect of your medical care with our providers and staff, please sign below and indicate to whom we may speak. □Check this box if you decline authorizing permission to others.
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Release of Information Form. I, hereby authorize Xxxxx Xxxxxx, Ph.D. to release information regarding my / my child’s case to, Name Address Information to be released: Psychoeducational Report/ Assessment Results Information regarding therapy sessions Other
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Related to Release of Information Form

  • Release of Information Except as required by law, no public release of any information, or confirmation or denial of same, with respect to this Contract or the subject matter hereof, will be made by SELLER or its subcontractors without the prior written approval of LOCKHEED XXXXXX. SELLER shall not use "Lockheed Xxxxxx," "Lockheed Xxxxxx Corporation," or any other trademark or logo owned by LOCKHEED XXXXXX, in whatever shape or form, without the prior written consent of LOCKHEED XXXXXX.

  • PUBLIC RELEASE OF INFORMATION Company does not endorse products or services. Accordingly, Xxxxxx agrees not to use Company’s name, the name Oak Ridge National Laboratory (ORNL), the name of any of its projects or programs, or identifying characteristics of any of these for advertising, marketing, or other promotional purposes, raising of capital, recommending investments, sale of securities, or in any way that implies endorsement by UT-Battelle, ORNL, or DOE. Any media releases concerning this Agreement are prohibited without written consent of the Subcontract Administrator.

  • CREDIT REVIEW AND RELEASE OF INFORMATION You authorize the Credit Union to investigate your credit standing when opening or reviewing your account. You authorize the Credit Union to disclose information regarding your account to credit bureaus and creditors who inquire about your credit standing. If your account is eligible for emergency cash and/or emergency card replacement services, and you request such services, you agree that we may provide personal information about you and your account that is necessary to provide you with the requested service(s).

  • Use of Information The Agent may not use any information gained in connection with this Agreement and the transactions contemplated by this Agreement, including due diligence, to advise any party with respect to transactions not expressly approved by the Company.

  • Update of Information If, prior to the Closing Time, any event shall occur or condition shall exist which would, singly or in the aggregate, result in a Material Adverse Effect the Company will promptly give the Winning Bidder(s), the Placement Agents and the Selling Shareholder written notice of such event or condition and effects therefrom, as well as copies of any related documentation.

  • Confidentiality and Use of Information (a) Consultant shall hold in trust for the District, and shall not disclose to any person, any confidential information. Confidential information is information which is related to the District's research, development, trade secrets and business affairs, but does not include information which is generally known or easily ascertainable by nonparties through available public documentation.

  • NON-DISCLOSURE OF INFORMATION In the event Executive's employment has been terminated pursuant to either Section 6(b) or Section 6(c) hereof, Executive agrees that, during the Restricted Period, Executive will not use or disclose any Proprietary Information of the Company for the Executive's own purposes or for the benefit of any entity engaged in Competitive Business Activities. As used herein, the term "Proprietary Information" shall mean trade secrets or confidential proprietary information of the Company which are material to the conduct of the business of the Company. No information can be considered Proprietary Information unless the same is a unique process or method material to the conduct of Company's Business, or is a customer list or similar list of persons engaged in business activities with Company, or if the same is otherwise in the public domain or is required to be disclosed by order of any court or by reason of any statute, law, rule, regulation, ordinance or other governmental requirement. Executive further agrees that in the event his employment is terminated pursuant to Sections 6(b) or 6(c) above, all Documents in his possession at the time of his termination shall be returned to the Company at the Company's principal place of business.

  • Release of Confidential Information No Party shall release or disclose Confidential Information to any other person, except to its Affiliates (limited by FERC Standards of Conduct requirements), subcontractors, employees, consultants, or to parties who may be considering providing financing to or equity participation with Developer, or to potential purchasers or assignees of a Party, on a need-to-know basis in connection with this Agreement, unless such person has first been advised of the confidentiality provisions of this Article 22 and has agreed to comply with such provisions. Notwithstanding the foregoing, a Party providing Confidential Information to any person shall remain primarily responsible for any release of Confidential Information in contravention of this Article 22.

  • Change of Information G.9.1 The Employer will provide the Union, on a quarterly basis, with a list of the names and addresses, and Employee number of Employees newly hired (permanent or temporary), on leave, including type of leave, or terminated as a result of resignation, retirement or death and Employees on layoff with recall rights.

  • Collection and Use of Information (a) Licensee acknowledges that Licensor may, directly or indirectly through the services of Third Parties, collect and store information regarding use of the Software and about equipment on which the Software is installed or through which it otherwise is accessed and used, through:

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