Release Forms

01. Release of Non-medical Information. The juvenile offender, parent or guardian, and Department representative must sign a release of information and consent form before information about the juvenile offender is released to any non-juvenile justice entity. A copy of the consent form must be maintained in the juvenile offender’s file at the program and in the case management file maintained by the Department. (3-31-22) 02. Release of Medical Information. Release of medical information requires more specific authorization. The Provider must abide by Subchapters B and C of these rules, as applicable. (3-31-22) 03. Minimum Information. The release of information and consent form must, at a minimum, include the following: (3-31-22) a. Name of person, agency, or organization requesting information; (3-31-22) b. Name of person, agency, or organization releasing information; (3-31-22) c. The specific information to be disclosed; (3-31-22) d. The date consent form is signed; (3-31-22) e. Signature of the juvenile offender and the parent or guardian, if the juvenile offender is under the age of 18; (3-31-22) f. The signature of the person witnessing the juvenile offender’s signature; and (3-31-22) g. Effective and expiration dates. (3-31-22)