Parental Consent to Release Personal Identifiable Information

The consent links below allow Local Education Agencies (LEA)s access to the required Special Education parental consent to release information for the purposes of Medicaid billing. LEAs should refrain from billing until the consent is signed by the parent.  Once signed, the consent is valid throughout the duration of the students enrollment in that district and will only require a notice each year after.  


Consent to Release Personal Identifiable Information

(2013-2014 School Year) - doc

Consent to Release Personal Identifiable Information Notice

(2013-2014 School Year) - doc

Consentimiento de los padres para dar información personal identificable  

(2013-2014 School Year) - doc

Consentimiento de los padres para dar información personal identificable aviso   

(2013-2014 School Year) - doc

 

Health Services Consent to Release Personal Identifiable Information     

(2013-2014 School Year) - doc

[Vision/Hearing, SBMH, Audiology, (Services outside the IEP)]

Consentimiento de Servicios de Salud para divulgar información de identificación personal-Spanish   

(2013-2014 School Year) - doc