Authorization to Release or Exchange Information

An Authorization to Release or Exchange Information is required for disclosures of Personal Health Information (PHI) that are not otherwise allowed by regulation and law. PHI is disclosed when it goes outside of therapy. For example, you might want another provider to get information about our work together. You can revoke an authorization at any time.

Victor Bloomberg, EdD, LCSW

Psychotherapist in San Diego since 1991. Doctorate in Higher Education and Social Change (2021).

https://vblcsw.com
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Consent to Share Information

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Coaching Agreement