How to complete Release of Information in Evolv

How to complete Release of information in Evolv

This article explains how to complete the most common Release of Information forms in Evolv:

• Release of Information (generic, schools, etc.)
  • Used for obtaining authorization from client/guardian to share information to/from with an outside source, i.e., DCF, School, healthcare provider, etc.
  • The Release of Information event is applicable to all programs in Evolv
• Primary Care Physician Release/Request
  • Used for obtaining authorization from client/guardian to share information to and from Primary Care Physician (PCP)
  • The PCP release is applicable to the following programs in Evolv:
    • Adoption - Case Management 
    • Adoption - Family Resource
    • _{Adoption - Inquiry/Search}
    • _{Adoption - International Adopt. Serv}
    • _{Adoption - Single Service (Child)}
    • _{Adoption - Single Service (Family)}
    • _{Adoption Journeys}
    • _{Certified Community Behavioral Health Ctr (CCBHC)}
    • _{Community Service Agency-Day Rate}
    • _{Community Service Agency-Family Support & Training} 
    • _{Empowering Families for Success (est. 2019)}
    • _{In Home Therapy}
    • _{Mental Health Clinic}
    • _{Mixed Population}
    • _{Parent Mentor} 
    • _{School Based Targeted Intervention Program}
    • _{Special Assessments}
    • _{Therapeutic Mentoring} 
    • _{Young Parent Support} 
    • Youth Community Crisis Stabilization (YCCS)
• Emergency Contact Release - for SUD clients only
  • Used for obtaining authorization from client/guardian to share information with specific emergency contact listed in Collaterals
  • The Emergency Contact Release release is applicable to the following programs in Evolv:
    • _{Certified Community Behavioral Health Ctr (CCBHC)}
    • _{Mental Health Clinic}
    • _{School Based Targeted Intervention Program}
    • True Course Program (TCP)
  • This release is very specific and ONLY to be completed once a client is given a diagnosis of SUD and is now involved in a 42 CFR Part 2 program: 
  • I hereby authorize Child & Family Services, Inc. to release/obtain information to the following person(s) in the event of a medical or mental health emergency, if the client drops out of treatment or withdraws from services against medical advice. 
  • Just because a client wants "Aunt Betty" to be listed to come pick them up from a session if ill...the client may NOT want "Aunt Betty" to know that they have a substance use issue and therefore they WOULD NOT list them as an emergency contact for purposes of this specific release.
  • This release is really allowing us to make contact with a specific person(s) in the event that we are concerned for the well-being and safety of the client due to dropping out of treatment, etc. It's truly to be allowed to reach out to someone in the event that re-lapse is a concern.
  • Also, this is an opportunity to review with the client who they currently have on file as an emergency contact to ensure that those people are still relevant. Please make the necessary changes if someone listed in the file is no longer considered an emergency contact by the client. Also, if the contact person for this specific release is not listed in the table you can add a new person right inside the release entry. 
    Please also note that a client can pick more than 1 person to add into the box as their choice for Emergency Contact release. Also, in the event that a client decides they want to change the person they listed (say like 3 months from now) they would have to revoke the original release and a brand new one would need to be filled out with the new contact person's name in it.
    **Clients can "Agree" to sign an emergency contact release, however due to BSAS requirements/reporting, clients can also "refuse" to sign this release all together. 
• Intra-Agency Release - for SUD clients only 
  • Used for obtaining authorization from client/guardian to share information with other providers within CFS
  • The Intra-Agency Release is applicable to the following programs in Evolv:
    • _{Certified Community Behavioral Health Ctr (CCBHC)}
    • _{Mental Health Clinic}
  • ONLY for SUD clients. 
  • Once the CI alert and SUD Modifier is added to the client, the intra-agency release should be one of the first things signed (hopefully "agreed" to and not "refused" so we can collaborate with other providers inside the agency 
• Revocation of Release
  • Used for revoking any existing releases (listed above) 
  • The Revocation of Release can only be chosen once any of the above release events are amended.
  • See specific article for more information -https://cfs.document360.io/v1/docs/revocation-of-release-instructions

Important Notes:

• Please read through all important information before continuing with this article 
• Be sure to follow all steps as written below. If there are any issues with this article, please report them to the IT Department immediately for corrections and additions.
• Check with your program regulations to ensure necessary releases are obtained, i.e., MHC requires a PCP release on file regardless if client has a PCP or not.
• Release of information forms can be found in either:
  • Client > Client Information > Personal Information > Releases/Requests
  • Some programs have these releases auto scheduled.  If event has been auto scheduled, complete auto scheduled task instead of creating a new event.
• Client's collaterals and health care professionals, including PCP, should be entered in:
  • Collaterals - Client > Client Information > Relationships > Collaterals 
  • Health Care Professionals - Evolv in Client > Client Information > Relationships > Health Practitioners
• Release of Information forms should be completed with client/guardian.
• Only required/necessary information needed should be shared. Blanket releases are not appropriate.
• Client/guardian should only sign completed releases (never a blank release)
• Client signatures should be captured within the Evolv form unless client is not accessible in which Docu Sign maybe be used.
• Once release is completed and signed by client/guardian, release should be e-signed by worker completing event

Instructions:

Release of Information (generic, schools, etc.)

Used for obtaining authorization from client/guardian to share information with an outside source, i.e., DCF, School, healthcare provider, etc.

1. Create or open event.
2. Complete Fields:
   1. Release/Request to/From - enter name of outside source.
   2. Type of Release - choose correct option from Type of Release table.
   3. Full Name and Mailing Address - enter full name and address (including street address, city, state, zip code) of person and/or organization.
   4. To Release the Following - choose correct option from table.
   5. Date Mailed - enter date the completed Release was mailed to outside source (if applicable)
   6. Person Mailing Release - enter staff name mailing Release (if applicable)
   7. Please Check All That Apply - check all that will be shared to/from with the outside source. 
      1. Check "All of the above" if all apply.
      2. Check "Other" if what is being shared is not listed.
   8. If Other was chosen, please specify - use when checking "Other"
   9. Please Mail Requested Information to - used when requesting information to be mailed back to Child & Family Services.  Choose correct address.
   10. Fax Requested Information To - used when requesting information to be faxed back to Child & Family Services.  Choose correct fax number.
   11. Or Electronically - to be used once Care Connect is functional.
   12. Permissions - Review with client/guardian.  Have client/guardian initial all 3 sections to verify they agree.
   13. Legal Disclosures - Review with client/guardian
   14. Excluding the Following - enter any exclusions stated by client/guardian.
   15. Signatures / Signature Dates- capture client/guardian signature and date
   16. Scanned Document - to be used when scanning a completed/signed Release of Information.
3. Save as Draft - if incomplete
4. Save and E-Sign when complete

Primary Care Physician Release/Request

Used for obtaining authorization from client/guardian to share information to and from Primary Care Physician (PCP)

1. Create or open event.
2. Complete Fields:
   1. Name of PCP - enter name of primary care physician (person/not organization).
   2. Client does not have a PCP - check here if client does not have an identified primary care physician.
      1. Skip to Signatures section
   3. Date Mailed - enter date the completed Release was mailed to outside source (if applicable)
   4. Person Mailing Release - enter staff name mailing Release (if applicable)
   5. Permission about Specific Health Information- only used for MHC and CCBHC programs
      1. Permission to share information my HIV information
         1. choose client's response from table
         2. Obtain client/guardian initials
      2. Permission to share Genetics Information - choose client's response from table
         1. choose client's response from table
         2. Obtain client/guardian initials
      3. Permission to share Information my Substance/Addictions Information - choose client's response from table 
         1. choose client's response from table
         2. Obtain client/guardian initials
   6. Describe any special concerns about this client - enter any information PCP should be made aware of
   7. Primary Care Physician Information - this subreport will list the PCP previously entered in client's Collateral section of Evolv.  

• If the PCP list is missing or incorrect, click on client name listed at the top of the form in the Event Information section

• Select Health Practitioners from the tabs in the Client Information Standalone form to end current PCP and enter correct PCP information. 

• Click on existing PCP 
• Enter end date and Save

• Select Add New then Health Practitioner

• Complete Health Practitioners form ensuring the "Type" selected is PCP.

• Save
  • Close standalone form by clicking on the "X" on the top right hand corner
  • Refresh PCP subreport (if Refresh des not work, save form and reopen)

1. Refusal to Communicate with PCP - check if client refuses to share information with PCP listed.
   1. Refusal Signature - obtain client signature here if client refuses.
   2. Remarks - used to add any additional remarks regarding PCP
2. Legal Disclosure - review legal disclosure with client/guardian
3. I agree to this release excluding the following- enter any exclusions listed by the client/guardian (if applicable)
4. Signatures - obtain client and/or guardian signature and signature date
5. Revocation of Release - see https://cfs.document360.io/v1/docs/revocation-of-release-instructions
6. Attention Primary Car Physician - this section is designed for the PCP off ice to complete and return with copy of PCP records
7. Please Mail Requested Information to - select Child & Family Services address for PCP to return completed form and records.
8. Fax Requested Information to - select fax number if information is to be faxed instead of mailed
9. Or Electronically To - to be used once Care Connect is functional.
10. Scanned Document - to be used when scanning a completed/signed Release of Information.
11. Save as Draft - if incomplete
12. Save and E-Sign when complete
13. Send as Alert to Support Staff to Mail - For the Clinics/CBHCs, the completed PCP release gets forwarded to the Admin Support staff for faxing either by Open Access staff (initial intake), or by the Clinician (annual) 

Emergency Contact Release 

Used for obtaining authorization from client/guardian to share information with emergency contacts.  This event is only used for clients with SUD diagnosis:

1. Create or open event.
2. Complete Fields:
   1. Consent for Emergency Contact - choose client/guardian answer to consent from table
   2. List Specific Name(s) (from Emergency Contact on File) below.  - list the collateral names from the subreport list that client agrees/refuses to contact and share information
   3. Add Emergency Contact here if not listed above - use the Collateral sub form to enter additional collaterals
      1. Be sure to end date any collaterals that no longer apply by navigating to the Collaterals section
   4. For the Purpose Of"- review with client/guardian
      1. Information Authorized to be Released
      2. Legal Disclosures
   5. Signatures - obtain client and/or guardian signature and signature date 
   6. Revocation of Release - see https://cfs.document360.io/v1/docs/revocation-of-release-instructions
   7. Scanned Document - to be used when scanning a completed/signed Release of Information.
   8. Save as Draft - if incomplete
   9. Save and E-Sign when complete
   10. Send as Alert to Support Staff to Mail

Intra-Agency Release  

Used for obtaining authorization from client/guardian to share information with other CFS providers.  This event is only used for clients with SUD diagnosis:

• Create or open event.
• Complete Fields:
  1. Consent to Intra-Agency Release - choose client/guardian answer to consent from table
  2. Legal Disclosure - review with client/guardian
  3. Excluding the Following - enter any exclusions stated by client/guardian (if applicable)
  4. Signatures - obtain client and/or guardian signature and signature date 
  5. Revocation of Release - see https://cfs.document360.io/v1/docs/revocation-of-release-instructions
  6. Scanned Document - to be used when scanning a completed/signed Release of Information.
  7. Save as Draft - if incomplete
  8. Save and E-Sign when complete
  9. Send as Alert to Support Staff to Mail