How to Document a Release of Information (Authorization to Disclose Confidential Information)

1. You must first have the client open, click the Search icon.
2. Type Release of Information into the search bar.
3. Click to select Release of Information (Client).

4. In the CDAG Program Enrollment window pop-up, click the drop down and click to select the appropriate program.
5. Click OK to continue.

6. Complete the Release To/Release From section. Make sure to select whether this authorization is to allow you to release information to this entity and/or obtain information from this entity.

a. If the person you’re completing this release for is already entered as a contact in the Client Information Screen, select “Contact” and then select the person from the drop down list “Release To/From”. This will bring in the contact person’s information.


b. If you’re completing a release for an organization, such as Social Services or a school, select “Organization/Provider”. This opens a button next to the Release To/From field. Clicking this brings up a pop-up window where you can enter the organization’s information. Click save. This will push this information to the ROI and save this information for future ROIs. Enter the organization’s information.

c. If you’re completing a release for a contact person that is not currently entered as a contact in the Client Information Screen, selecting “Contact” will create an opportunity to select the button “Open Contacts”. This will take you to the Client Information Screen, where you can add additional contact.

7. Complete the Purpose of Disclosure section. Most authorizations to disclose information are for treatment and/or care coordination, but others may apply. Select the appropriate boxes. If you select “Other”, make sure to clarify.
8. Complete the Expiration section. The start date automatically fills with today’s date. If you don’t change anything in this section, the document will automatically expire 1 year from today’s date.
9. Complete the Information to be Used or Disclosed section. Select all records that are authorized for disclosure per the client’s request.
a. If the client requests that only records from a certain time frame be shared, include the start and end dates. 

10. If the client wishes to put any restrictions on this authorization, enter those in the Restrictions section.
11. The terms section provides the client with information about the authorization they’re signing. Make sure to check both boxes to demonstrate you’ve reviewed this information with the client.

12. Enter your agency’s information in the Agency Contact Information section.
13. The Other section allows you to document if the client received or declined a copy of the document. It also allows you to document how you verified the client’s identity as the appropriate person to sign this document.
14. The Additional information section must be completed to document the disclosure of certain types of information. The client must opt to either authorize or prohibit each of these specialty types of information.

15. Click Sign to complete and generate the document.

16. This will create the PDF version of the form. Click the Plus icon in the upper right corner of the PDF viewer.

17. This opens the signature details. Select the client and/or guardian from the Signer field. You will need to select each cosigner one at a time, so repeat these steps as needed.
18. Click Co-Sign.

19. This brings up the Signature Page pop-up window. The co-signer can now sign using a signature pad, a mouse, or a touchpad to capture their signature. You can also designate that the client has signed on a paper version of the document or that they client verbally agreed and was unable to sign. If the client has signed a paper version of the form, that form should be scanned in. See How do I scan in a document to the client’s chart?
a. Select the method of capturing the signature. NOTE: Regulations require a signature for documents related to releasing information, so you should not select the “Verbally Agreed Over Phone” option on this document.
b. Once the co-signer is happy with their signature, click the Save button. If the client has signed a paper version of the form or has agreed verbally and is unable to sign electronically at this point, these are other options.
c. If the cosigner needs to start over, click the Clear button to erase the current signature.

Once signed by all required people, you are finished.