Please talk to your patient and obtain consent for you to consult with C-PAC. When we receive your call, we assume that you have already discussed   C-PAC with your patient and they are agreeing to the psychiatric guidance or assistance that C-PAC provides.

C-PAC services do not require a signed Release of Information form. While the information you share with us is sensitive and confidential, neither the PCP nor C-PAC needs to obtain a signed Release of Information form. Why? Because HIPAA rules and guidelines allow for “covered entities” to provide care coordination without a signed Release of Information form. Additionally, during the psychiatric phone consultation there is no Protected Health Information being exchanged.

There is one exception to this! Title 42 CFR requires that in order for any information related to substance misuse to be disclosed, a signed Release of Information must be obtained. To learn more about Title 42 CFR click here.

To download a blank Release of Information form, click on this link: Release of Information form PDF