{"id":16884,"date":"2024-11-08T18:41:05","date_gmt":"2024-11-08T18:41:05","guid":{"rendered":"https:\/\/namhs.com\/?page_id=16884"},"modified":"2025-08-06T23:55:51","modified_gmt":"2025-08-06T23:55:51","slug":"revocation-of-release-of-information","status":"publish","type":"page","link":"https:\/\/namhs.com\/revocation-of-release-of-information\/","title":{"rendered":"Revocation of Release of Information (ROI) Form"},"content":{"rendered":"
[vc_row][vc_column][vc_empty_space height=”15em”][vc_btn title=”Back to All Forms” style=”classic” shape=”round” color=”info” align=”center” css=”” link=”url:%2Fnamhs-therapy-forms%2F|title:Forms”][vc_column_text css=””][\/vc_column_text][vc_separator color=”custom” border_width=”3″ el_width=”10″ accent_color=”#000000″][\/vc_column][\/vc_row][vc_row][vc_column width=”1\/4″][\/vc_column][vc_column width=”1\/2″][vc_column_text css=””]\n

Revocation of Release of Information (ROI) Form<\/h1>\n

Use the form below if you voluntarily authorize the disclosure of information from your health record at NAMHS. Please specifically state whom you would like the records released to. Also indicate the purpose or need for this disclosure.<\/p>\n[\/vc_column_text][\/vc_column][vc_column width=”1\/4″][\/vc_column][\/vc_row][vc_row][vc_column width=”1\/4″][\/vc_column][vc_column width=”1\/2″][vc_raw_html css=””]JTNDc2NyaXB0JTIwdHlwZSUzRCUyMnRleHQlMkZqYXZhc2NyaXB0JTIyJTIwc3JjJTNEJTIyaHR0cHMlM0ElMkYlMkZmb3JtLmpvdGZvcm0uY29tJTJGanNmb3JtJTJGMjQyOTY1NzE3Mzc2MDY2JTIyJTNFJTNDJTJGc2NyaXB0JTNF[\/vc_raw_html][\/vc_column][vc_column width=”1\/4″][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row][vc_column][vc_empty_space height=”15em”][vc_btn title=”Back to All Forms” style=”classic” shape=”round” color=”info” align=”center” css=”” link=”url:%2Fnamhs-therapy-forms%2F|title:Forms”][vc_column_text css=””][\/vc_column_text][vc_separator color=”custom” border_width=”3″ el_width=”10″ accent_color=”#000000″][\/vc_column][\/vc_row][vc_row][vc_column width=”1\/4″][\/vc_column][vc_column width=”1\/2″][vc_column_text css=””] Revocation of Release of Information (ROI) Form Use the form below if you voluntarily authorize the disclosure of information from your health record at NAMHS. Please specifically state whom you would like the records released…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-16884","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nRevocation of Release of Information At NAMHS<\/title>\n<meta name=\"description\" content=\"Revocation of Release of Information at North American Mental Health Services in Redding, Fairfield, and Eureka, California.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/namhs.com\/revocation-of-release-of-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Revocation of Release of Information At NAMHS\" \/>\n<meta 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