AUTHORIZATION FOR RELEASE OF INFORMATION
I am an applicant or client for financial assistance and/or supportive services from Minnehaha/Lincoln County Department of Human Services (HS). To determine my eligibility for and continued use of HS resources, and to comply with relevant laws and HS procedures, HS must develop an adequate record of my physical, mental, academic, drug or alcohol abuse, social and economic condition or housing situation. Therefore, I hereby authorize (1) any individual or agency of any nature to release and furnish to HS any information in their files HS believes is necessary to complete my record; and (2) I hereby authorize HS to release to such agency or individual my information HS believes is necessary to complete my record.
This authorization is in effect unless or until revoked in writing.
A copy of this release shall be as valid as the original.