Publications
Initial application for written consent to engage in the business of insurance in the District of Columbia pursuant to 18 USC section 1033 and 1034
Standard application for the written consent to engage in the business of insurance in the District of Columbia.
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.