32 Miss. Code. R. § 21-3-3.2 - Statement of Consent for Disclosure
All applicants, clients, or client representatives are to be informed of the confidentiality of records. Release of such information must be by written consent of the client or authorized representative and must include:
1. name and Social Security
number of the client;
2.
designation of the parties to whom the information may be released;
3. nature of the information to be
released;
4. specific purposes for
which the released information may be used;
5. designation of the Agency person
authorized to disclose the information;
6. dates of initiation and termination of
consent; and,
7. signature of the
client and/or client representative.
Notes
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