Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Confidentiality and Consent Forms


Although the layout of the confidentiality forms are unique to each state, there is little variation across the states with regard to content and use. Every state requires a client to sign a release of information allowing mental health staff to share information with the welfare agency and other service providers. Clients are also notified about the types of information that are kept confidential. In some states, clients are required to sign a statement declaring that they are voluntarily participating in mental health services. In each state, licensed mental health professional (or mental health staff under the supervision of a licensed mental health professional) complete the forms. The forms used in the study states include:

  • Utah: Disclosure/Verification Form and Authorization for Release of Information Form
  • Tennessee: Consent for Release of Confidential Information Form and Informed Consent Form
  • Oregon: Authorization for Release of Information Form
  • Florida: Consent for the Release of Confidential Information Form.

Confidentiality and Consent forms for all sites [in PDF format]


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"TANF-MH01.pdf" (pdf, 763.2Kb)

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