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Department of Insurance, Securities and Banking
 

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The Department of Insurance, Securities and Banking has a new address: 1050 First Street, NE, Suite 801, Washington, DC 20002.

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Release of Mental Health Information for Outpatient Mental Health Treatment Form


This form is designed to authorize the disclosure of mental health information listed below by the individual practitioner to determine entitlement of paymant of claims or reimbursement.  It is not to be used for in-patient or partial hospitalization.