10A NCAC 05J .0206 RELEASE OF CLIENT INFORMATION
(a) No client identifying information, except as referenced in Rule .0205 of this Section, which is maintained by the Division of Aging, Area Agency on Aging or service provider shall be released to other individuals or community service organizations without obtaining a signed consent for release of information from the client or legal guardian.
(b) The consent for release of information shall include, at a minimum, the following items:
(1) Name of the provider and recipient of the information;
(2) The extent of information to be released;
(3) The name and dated signature of the client or client representative;
(4) A statement that the consent is subject to revocation at any time except to the extent that action has been taken in reliance on the consent;
(5) Length of time the consent is valid.
(c) The client may alter the form to contain other information which may include but is not limited to:
(1) A statement specifying the date, event or condition upon which the consent may expire even if the client does not expressly revoke the consent;
(2) Specific purpose for the release.
(d) A copy of the signed consent for release of information shall be maintained in the client record.
History Note: Authority G.S. 143B‑181.1(c); 143B‑181.10;
Eff. November 1, 1991;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 23, 2015.