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Consent Templates and Guidance - ohsrp.nih.gov
WebIf the applicant wishes to be referred to another county’s RRP, please state no more than three (3) specific jurisdictions on the RRP Consent for Release of Information Form. If the applicant needs a specialty service, please review the following grid to determine that service: SERVICE CSA JURISDICTION TAY (Transitional Age Youth) WebIf the applicant wishes to be referred to another county’s RRP, please state no more than three (3) specific jurisdictions on the RRP Consent for Release of Information Form. If the … ms store install windows 10
Consent Templates and Guidance - ohsrp.nih.gov
WebYou must sign the RRP Consent for Release of Information Form which is part of the application. Most mental health professionals have access to the application; however, an application may be obtained through your county’s Core Service Agency (CSA): Cecil County CSA, 401 Bow Street, Elkton, MD 21921 Phone: 410-996-5112 Fax: 410-996-5134 WebCONSENT: My consent and authorization for this elective procedure is strictly voluntary. By signing this informed consent form, I hereby grant authority to the physician/practitioner to perform Platelet Rich Plasma “aka" PRP injections to a r ea(s) discussed during our consultation, fothe purpose of aesthetic r enhancement and skin rejuvenation. WebYou must sign the RRP Consent for Release of Information Form which is part of the application. Most mental health professionals have access to the application; however, an application may be obtained through your county’s Core Service Agency (CSA): Cecil County CSA, 401 Bow Street, Elkton, MD 21921 Phone: 410996-5112 Fax: 410-996-5134 ms store hours