The Release Of Information Form Mental Health is a critical document used in Canadian healthcare settings when there is a need to share confidential mental health information with authorized third parties. This document becomes necessary when mental health records need to be transferred between healthcare providers, shared with insurance companies, or released to other authorized parties with the patient's explicit consent. The form ensures compliance with Canadian federal privacy laws such as PIPEDA, as well as provincial health information protection acts and mental health legislation. It includes specific provisions for the type of information to be shared, duration of the authorization, and the rights of the patient regarding their personal health information. The document serves as both a legal protection mechanism for healthcare providers and a means of ensuring patient privacy rights are respected in the information sharing process.

1. Patient Information: Patient's full legal name, date of birth, contact information, and any relevant identification numbers

2. Healthcare Provider Information: Details of the healthcare provider/facility releasing the information, including name, address, and contact information

3. Recipient Information: Details of the person or organization authorized to receive the information, including name, role/relationship, organization (if applicable), and contact information

4. Information to be Released: Specific description of the mental health information to be disclosed, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of the reason for releasing the information

6. Duration of Authorization: Specific time period for which the authorization is valid

7. Rights and Notifications: Statement of patient's rights, including right to revoke authorization and any limitations

8. Signatures and Date: Space for patient or legal representative signature, date, and witness signature if required