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AUTHORIZATION TO RELEASE INFORMATION
Authorization to Release Information
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I authorize Ask My Advocate to obtain my information regarding the complete file. This representative shall have access to all information of matters related to instructional planning, educational planning, mental health services and occupational or physical therapy services related to the IEP, all communication between provision for the individual. This authorization is also intended to cover access to related serivce information that may affect files maintained byt those related service providers such as Regional Center , California Children Services, Department of Mental Health, group homes and other agencies. I understand that this release constitutes as a waiver under the Federal Education Rights Privacy Act (FERPA) as well as the Health Insurance Portability Accountability Act of 1996 (HIPPA).
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This authorization shall remain in effect until terminated in writing by the client or by Ask My Advocate.
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