CFS 600-3: Release of Information
Please read the instructions below prior to completing the request. Failure to follow instructions may result in a processing delay.
Instructions:
Please complete one request for each entity you would like to release information to. This form is not for the "exchange" of information; two separate form submissions are required to release information between agencies/persons.
Submitting a Single Consent Form:
If you are only submitting one request for the youth, do NOT fill out the CFS 600-3 form prior to submission. When asked if you would like to submit multiple requests for the same youth, choose ‘No’ and fill out the remaining fields. Upon submission, the CFS 600-3 form will be generated for you.
Submitting Multiple Consent Forms for the Same Youth:
If you would like to submit multiple CFS 600-3 forms for the same youth, you may submit them in a single submission through the portal (maximum of 25). Please follow the steps below. Requests for different youth must be submitted separately.
1. Fill out each CFS 600-3 form in its entirety and combine all completed forms into a single PDF file. Click here for a blank CFS 600-3 form. When submitting multiple forms for one youth, the portal will not generate the filled out CFS form for you.
2. Begin your submission in the portal by completing the requestor information and youth information
3. In the Request type form step, select ‘Yes’ when asked if you would like to submit multiple requests for the same youth and indicate the number of forms you are submitting (maximum of 25 in one submission).
4. Upload the combined PDF file to the consent form upload field.
Please be aware of the following when completing the request:
1. Do not use acronyms anywhere in the request.
2. Provider and receiver information cannot be generic, e.g. GAL, physician, and caseworker are not acceptable. Please provide the specific name and address of the of person/ agency.
3. Use the appropriate type of information category and do not repeat the same specification in another category.
4. When specifying the type of information being released, do not use non-specific language such as records, reports, and assessments. Never use "any and all".
5. Only use information type "other" when necessary.
6. Only request information absolutely necessary to release to each entity. For example, physicians, dentists, therapists, and schools likely need different information.
7. When completing the purpose for requesting this information, please keep in mind the minor, who is releasing the information, and who the information is being provided to.
8. Consent is never granted for redisclosure.
