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Release of Information

There are times when you need a provider to share protected personal and health information with a designated recipient. The ROI form helps us:

 

  • Retrieve past personal or medical information from past providers and/or facilities to transfer to Evolve Psychiatry

  • Send copies of records to be sent from our clinic to outside providers and/or facilities

For assistance with obtaining outside records

For Evolve Psychiatry treatment and records

Patient and Nurse

Authorization of Representative

The AOR form allows Evolve Psychiatry staff to involve your loved ones in your care with regards to disclosing health, financial, and/or emergency information

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