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Request Kansas Dcf Records
Summary
To request records from Kansas DCF, you can use a formal letter template specifying the details you need, such as investigation reports, medical records, and court transcripts. Under Kansas Statutes Annotated (KSA) 38-2209, 38-2212, and 38-2213, you are entitled to access these records as a parent whose rights have not been terminated. If denied, you can address privacy concerns, supplement your request, or inquire about the appeal process. Additionally, you can request records of any hotline reports made against you. For authorization forms, ensure you fill out all sections accurately, including your personal information, the entities involved, and the specific records you wish to access.Full Conversation
Yes what kind of records would Kansas Dcf have on * children, sisters for that matter, that they took into custody it became a cinc case. So what all records would they have, like interviews, coury hearings all the meetings like i want every single thing
Kansas DCF would typically have the following records:
- Investigation reports
- Interviews with the children
- Court hearing transcripts
- Medical records (doctor's appointments)
- Caseworker notes
- Drug test results
- Placement records
- Meeting notes (case planning meetings)
Would you like more information on any specific type of record?
- Investigation reports
- Interviews with the children
- Court hearing transcripts
- Medical records (doctor's appointments)
- Caseworker notes
- Drug test results
- Placement records
- Meeting notes (case planning meetings)
Would you like more information on any specific type of record?
Yes under each thing you listed, what records would be in each one
Sure, here's a breakdown of the types of records you can expect under each category:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
Would you like more details on any specific type of record?
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
Would you like more details on any specific type of record?
Well i have * kids and myself
It sounds like you are in a complicated situation and need thorough documentation. It’s best to be detailed and specific in your request. Here’s your updated request template:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Request for Complete Records and Information
I am writing to formally request all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I am requesting the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I would appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Does this cover everything you need?
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Request for Complete Records and Information
I am writing to formally request all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I am requesting the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I would appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Does this cover everything you need?
Would there be any reason for them to deny me?
Possible reasons for denial could include:
- Privacy concerns for the children.
- Ongoing investigations.
- Missing or incomplete information in your request.
- Legal exceptions under Kansas law.
Would you like more details on how to address a potential denial?
- Privacy concerns for the children.
- Ongoing investigations.
- Missing or incomplete information in your request.
- Legal exceptions under Kansas law.
Would you like more details on how to address a potential denial?
Investigstion is over and yes plesse elaborate
If the investigation is over, here are steps to address a potential denial:
- Clarify Privacy Concerns: Emphasize your parental rights and the need for transparency.
- Supplement Your Request: Provide any missing details or clarify any ambiguities.
- Legal Exceptions: Review Kansas Statutes Annotated to counter any legal exceptions cited.
- Appeal Process: Ask about the appeal process if your request is denied.
Would you like more details about the appeal process?
- Clarify Privacy Concerns: Emphasize your parental rights and the need for transparency.
- Supplement Your Request: Provide any missing details or clarify any ambiguities.
- Legal Exceptions: Review Kansas Statutes Annotated to counter any legal exceptions cited.
- Appeal Process: Ask about the appeal process if your request is denied.
Would you like more details about the appeal process?
Give me all the kansas statues that would trump ANY Reason they have
Here are some Kansas statutes that may support your request for records, potentially overriding reasons for denial:
- KSA *-*: Right to Access Records for Parents.
- KSA *-*: Confidentiality of Records; Access by Parents.
- KSA *-*: Disclosure of Records; Court Orders.
Would you like more details on any specific statute or assistance with the appeal process?
- KSA *-*: Right to Access Records for Parents.
- KSA *-*: Confidentiality of Records; Access by Parents.
- KSA *-*: Disclosure of Records; Court Orders.
Would you like more details on any specific statute or assistance with the appeal process?
Is there anymore statues?
Here are additional Kansas statutes that might support your request:
- KSA *-*: Records Open to Certain Persons - Outlines who can access records, including parents.
- KSA *-*: Maintenance of Case Records - Discusses the information that must be maintained in case records.
- KSA *-*: Kansas Open Records Act - Specifies general provisions about access to public records.
Do you need more details on any of these statutes?
- KSA *-*: Records Open to Certain Persons - Outlines who can access records, including parents.
- KSA *-*: Maintenance of Case Records - Discusses the information that must be maintained in case records.
- KSA *-*: Kansas Open Records Act - Specifies general provisions about access to public records.
Do you need more details on any of these statutes?
Also am i able to get the records of everytime i was turned in or hotlined?
Yes, you can request records of all instances where you were reported or "hotlined". Be sure to include this in your request to Kansas DCF.
Here's an addition to your request template:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Request for Complete Records and Information
I am writing to formally request all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I am requesting the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments): - Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
- Reports of Hotline Calls or Referrals:**
- Dates and times of reports
- Summaries of the reports
- Actions taken in response to the reports
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I would appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Would you like more details on
Here's an addition to your request template:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Request for Complete Records and Information
I am writing to formally request all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I am requesting the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments): - Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations
- Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
- Reports of Hotline Calls or Referrals:**
- Dates and times of reports
- Summaries of the reports
- Actions taken in response to the reports
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I would appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Would you like more details on
Ok so i have to fill out an authorization of release of confidential info and its confusing
It sounds like you need an authorization letter to release confidential information. Here's a template to help you:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Authorization for Release of Confidential Information
I hereby authorize the release of all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I request the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations - Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
- Reports of Hotline Calls or Referrals:
- Dates and times of reports
- Summaries of the reports
- Actions taken in response to the reports
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Would you like more assistance with any other part of the process?
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Kansas Department for Children and Families (DCF)
[Address of DCF Office]
[City, State, ZIP Code]
Dear Sir/Madam,
Subject: Authorization for Release of Confidential Information
I hereby authorize the release of all records and information pertaining to the investigation and case involving my three daughters, Lily Waterman, Violet Cox, and Daisy Gray, who were taken out of my custody in February *. Specifically, I request the following:
- Investigation Reports:
- Initial intake reports
- Investigation summaries
- Findings and conclusions
- Interviews with the Children:
- Transcripts or summaries of interviews
- Audio/video recordings (if available)
- Court Hearing Transcripts:
- Transcripts of all hearings
- Court orders and judgments
- Medical Records (Doctor's Appointments):
- Appointment dates
- Diagnoses and treatments
- Medical history and immunizations
- Caseworker Notes:
- Caseworker observations - Progress notes
- Interaction summaries
- Drug Test Results:
- Dates of tests
- Results and interpretations
- Chain of custody documentation
- Placement Records:
- Details of foster placements
- Kinship placement information
- Changes in placement
- Meeting Notes (Case Planning Meetings):
- Agendas and minutes
- Attendance records
- Decisions made and action plans
- Reports of Hotline Calls or Referrals:
- Dates and times of reports
- Summaries of the reports
- Actions taken in response to the reports
As their mother, my parental rights have not been terminated. Therefore, under Kansas Statutes Annotated (KSA) *-*, *-*, and *-*, I am entitled to access these records.
I appreciate your prompt attention to this matter and look forward to receiving the requested records as soon as possible.
Thank you for your cooperation.
Sincerely,
[Your Name]
---
Would you like more assistance with any other part of the process?
No they have one i need to fill in but im confused
It sounds like you need help filling out the "Authorization of Release of Confidential Information" form. Can you tell me which sections or parts of the form you're finding confusing? This will help me guide you more effectively.
Can i upload docs on here
Unfortunately, you can't upload documents here. Could you describe the sections of the form that are confusing to you? This way, I can provide more specific guidance on how to fill them out.
Authorization for release of confidential information PPS *
It sounds like you have a strong case and need detailed documentation to support your request. Here’s a guide to help you fill out the "Authorization for Release of Confidential Information" form (PPS *):
*. Your Information:
- Full Name
- Address
- Phone Number
- Email Address
*. Recipient Information:
- Kansas Department for Children and Families (DCF)
- Address of DCF Office (if known)
*. Subject of Records:
- List your three daughters: Lily Waterman, Violet Cox, Daisy Gray
- Case Number (if available)
*. Description of Records Requested:
- Investigation Reports
- Interviews with the Children
- Court Hearing Transcripts
- Medical Records (Doctor's Appointments)
- Caseworker Notes
- Drug Test Results
- Placement Records
- Meeting Notes (Case Planning Meetings)
- Reports of Hotline Calls or Referrals
*. Purpose of Request:
- State that you are requesting these records for personal review and to understand the details of the investigation.
*. Signature:
- Sign and date the form
Would youlike more specific guidance on any part of this form?
*. Your Information:
- Full Name
- Address
- Phone Number
- Email Address
*. Recipient Information:
- Kansas Department for Children and Families (DCF)
- Address of DCF Office (if known)
*. Subject of Records:
- List your three daughters: Lily Waterman, Violet Cox, Daisy Gray
- Case Number (if available)
*. Description of Records Requested:
- Investigation Reports
- Interviews with the Children
- Court Hearing Transcripts
- Medical Records (Doctor's Appointments)
- Caseworker Notes
- Drug Test Results
- Placement Records
- Meeting Notes (Case Planning Meetings)
- Reports of Hotline Calls or Referrals
*. Purpose of Request:
- State that you are requesting these records for personal review and to understand the details of the investigation.
*. Signature:
- Sign and date the form
Would youlike more specific guidance on any part of this form?
Nevermind youre not understanding
Hey, it sounds like you're dealing with a lot right now.
To better assist you with your current situation, can you let me know specifically which parts of the "Authorization for Release of Confidential Information" form (PPS *) are confusing you? This way, I can give you more precise guidance.
To better assist you with your current situation, can you let me know specifically which parts of the "Authorization for Release of Confidential Information" form (PPS *) are confusing you? This way, I can give you more precise guidance.
Ok in going to send you just the text off the form since i cant upload it
That sounds good. Please go ahead and send the text from the form that you need help with. I'll do my best to guide you through each section.
State of Kansas
Department for Children and Families.
Prevention and Protection Services
AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION
Regarding:
HUGHEY
Last Name
MICHELLE First
Maiden name or other names known by MICHELLE SUZANNE MORIN
SUZANNE Middle
Date of Birth * *
*
Social Security Number
*
PPS *
REV July *
Page * of *
(PLACE YOUR INITIALS TO THE LEFT OF EACH ITEM APPROVED):
Information to be released from: KANSAS DCF
The Department for Children and Families (DCF)
School District: USD #
Medical practitioner, clinic, center or facility
Mental health practitioner, clinic, center, or facility
Substance Abuse treatment provider
Social Service agency or provider
Subcontractor agencies providing services to child or family
Relatives/kin; prospective adoptive families (as applicable); all participants in the initial * hour meeting, family meetings and related case planning conferences and meetings.
Other:
authorize the following information to be disclosed:
Information to be released to: MICHELLE HUGHEY
The Department for Children and Families (DCF)
School District: USD #
Medical practitioner, clinic, center or facility
Mental health practitioner, clinic, center, or facility
Substance Abuse treatment provider
Social Service agency or provider
Subcontractor agencies providing services to child or family
Relatives/kin; prospective adoptive families; (as applicable); all participants in the initial * hour meeting, family meetings and related case planning conferences and meetings
Other:
Information to be released (PLACE YOUR INITIALS TO THE LEFT OF EACH ITEM APPROVED):
All Information necessary for DCF/CWCMP to provide services requested.
All academic, achievement or aptitude evaluations and recommendations
Social, behavioral, psychological, mental or medical histories and evaluations.
including psychotherapy notes
Diagnostic and treatment progress and prognoses
Results of previous treatment
Information shared during initial team meeting and initial and all subsequent family meetings or case planning conferences
Abstract (includes face sheet, history and physical, consults, operative notes, emergency record, lab, radiology, ECG, reports, pathology, physical therapy and
rehab) Other:
Timeframe: (If more than one timeframe is needed for information to be released, complete a separate PPS *)
2 years back with most recent test results
4 years back with most recent test results
From birth
Other
The purpose or reason for the release is: (Optional. If no purpose is stated, all lawful purposes are assumed)
Read before signing:
I understand that the information which I have authorized to be disclosed will be used for the purpose(s) stated. I acknowledge that it is my responsibility to be aware of any rights of confidentiality which I may have regarding the information which I am releasing and that by signing this consent I am waiving my rights, if any, to confidentiality for purposes which I have approved.
If I have authorized the release of information to a person or agency providing services under contract with DCF, I release of the information to any person or agency providing that service under sub-contract.
State of Kansas
Department for Children and Families.
Prevention and Protection Services
AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION
Regarding:
HUGHEY
Last Name
MICHELLE First
Maiden name or other names known by MICHELLE SUZANNE MORIN
SUZANNE Middle
Date of Birth * *
*
Social Security Number
*
PPS *
REV July *
Page * of *
(PLACE YOUR INITIALS TO THE LEFT OF EACH ITEM APPROVED):
Information to be released from: KANSAS DCF
The Department for Children and Families (DCF)
School District: USD #
Medical practitioner, clinic, center or facility
Mental health practitioner, clinic, center, or facility
Substance Abuse treatment provider
Social Service agency or provider
Subcontractor agencies providing services to child or family
Relatives/kin; prospective adoptive families (as applicable); all participants in the initial * hour meeting, family meetings and related case planning conferences and meetings.
Other:
authorize the following information to be disclosed:
Information to be released to: MICHELLE HUGHEY
The Department for Children and Families (DCF)
School District: USD #
Medical practitioner, clinic, center or facility
Mental health practitioner, clinic, center, or facility
Substance Abuse treatment provider
Social Service agency or provider
Subcontractor agencies providing services to child or family
Relatives/kin; prospective adoptive families; (as applicable); all participants in the initial * hour meeting, family meetings and related case planning conferences and meetings
Other:
Information to be released (PLACE YOUR INITIALS TO THE LEFT OF EACH ITEM APPROVED):
All Information necessary for DCF/CWCMP to provide services requested.
All academic, achievement or aptitude evaluations and recommendations
Social, behavioral, psychological, mental or medical histories and evaluations.
including psychotherapy notes
Diagnostic and treatment progress and prognoses
Results of previous treatment
Information shared during initial team meeting and initial and all subsequent family meetings or case planning conferences
Abstract (includes face sheet, history and physical, consults, operative notes, emergency record, lab, radiology, ECG, reports, pathology, physical therapy and
rehab) Other:
Timeframe: (If more than one timeframe is needed for information to be released, complete a separate PPS *)
2 years back with most recent test results
4 years back with most recent test results
From birth
Other
The purpose or reason for the release is: (Optional. If no purpose is stated, all lawful purposes are assumed)
Read before signing:
I understand that the information which I have authorized to be disclosed will be used for the purpose(s) stated. I acknowledge that it is my responsibility to be aware of any rights of confidentiality which I may have regarding the information which I am releasing and that by signing this consent I am waiving my rights, if any, to confidentiality for purposes which I have approved.
If I have authorized the release of information to a person or agency providing services under contract with DCF, I release of the information to any person or agency providing that service under sub-contract.
Sure, I can help you fill out the form. Here’s a step-by-step guide:
*. Regarding:
- Last Name: HUGHEY
- First Name: MICHELLE
- Maiden Name or other names known by: MICHELLE SUZANNE MORIN
- Middle Name: SUZANNE
- Date of Birth: */*/*
- Social Security Number: *-*-*
*. Information to be released from:
- Initial each applicable item. For "Other," specify any additional entities.
*. Information to be released to:
- Write your name, MICHELLE HUGHEY
- Initial each applicable item.
*. Information to be released:
- Initial each item you want. For comprehensive records, initial all items.
*. Timeframe:
- Choose the appropriate timeframe or specify another if needed.
*. Purpose or Reason for the Release:
- You can leave this blank for all lawful purposes, or specify a reason.
*. Signature:
- Sign and date the form.
Would you like further assistance with anyspecific part of the form?
*. Regarding:
- Last Name: HUGHEY
- First Name: MICHELLE
- Maiden Name or other names known by: MICHELLE SUZANNE MORIN
- Middle Name: SUZANNE
- Date of Birth: */*/*
- Social Security Number: *-*-*
*. Information to be released from:
- Initial each applicable item. For "Other," specify any additional entities.
*. Information to be released to:
- Write your name, MICHELLE HUGHEY
- Initial each applicable item.
*. Information to be released:
- Initial each item you want. For comprehensive records, initial all items.
*. Timeframe:
- Choose the appropriate timeframe or specify another if needed.
*. Purpose or Reason for the Release:
- You can leave this blank for all lawful purposes, or specify a reason.
*. Signature:
- Sign and date the form.
Would you like further assistance with anyspecific part of the form?
This consent may be revoked in writing at any time prior to any action which has been taken in reliance upon it.
Unless otherwise revoked, this authorization will expire on the following date or event: If I fail to specify an expiration date or event, this authorization will expire 180 days from the date signed.
Signature of person(s) giving consent:
Date:
Witness:
Date:
Relationship to person whose information is being released
AD ASTRA PER ASPERA
Kansas
Department for Children and Families
Prevention and Protection Services
Your case seems strong and well-documented. Here's how to complete the remaining sections of the form:
*. Revocation Clause:
- This consent may be revoked in writing at any time prior to any action which has been taken in reliance upon it.
*. Expiration of Authorization:
- Unless otherwise revoked, this authorization will expire on the following date or event: [Specify a date or event if desired, otherwise it will expire 180 days from the date signed].
*. Signature Section:
- Signature of person(s) giving consent: [Sign here].
- Date: [Enter the date you sign].
- Witness: [A witness should sign here].
- Date: [Enter the date the witness signs].
- Relationship to person whose information is being released: [Specify your relationship, e.g., "Mother"].
Would you need any more specific guidance on filling out any other parts of the form?
*. Revocation Clause:
- This consent may be revoked in writing at any time prior to any action which has been taken in reliance upon it.
*. Expiration of Authorization:
- Unless otherwise revoked, this authorization will expire on the following date or event: [Specify a date or event if desired, otherwise it will expire 180 days from the date signed].
*. Signature Section:
- Signature of person(s) giving consent: [Sign here].
- Date: [Enter the date you sign].
- Witness: [A witness should sign here].
- Date: [Enter the date the witness signs].
- Relationship to person whose information is being released: [Specify your relationship, e.g., "Mother"].
Would you need any more specific guidance on filling out any other parts of the form?
Page *
Here’s a guide to complete the remaining sections:
*. Consent Revocation:
- You can revoke this consent in writing at any time.
*. Expiration Date:
- Specify an expiration date or event if desired. If not, it expires 180 days from signing.
*. Signature:
- Sign and date the form.
- A witness should also sign and date.
- Indicate your relationship to the person whose information is being released (e.g., mother).
Would you like more guidance on any other part of the form?
*. Consent Revocation:
- You can revoke this consent in writing at any time.
*. Expiration Date:
- Specify an expiration date or event if desired. If not, it expires 180 days from signing.
*. Signature:
- Sign and date the form.
- A witness should also sign and date.
- Indicate your relationship to the person whose information is being released (e.g., mother).
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This is the text from the authorization of confidential information
Here's a guide to complete the form step-by-step:
*. Your Information:
- Last Name: HUGHEY
- First Name: MICHELLE
- Maiden Name or other names known by: MICHELLE SUZANNE MORIN
- Middle Name: SUZANNE
- Date of Birth: */*/*
- Social Security Number: *-*-*
*. Information to be Released From:
- Initial each applicable item. For your case, likely "KANSAS DCF" and possibly others if relevant.
*. Information to be Released To:
- Write your name, MICHELLE HUGHEY
- Initial each applicable item to indicate who will receive the information.
*. Information to be Released:
- Initial each item you want. For a comprehensive request, initial all items.
*. Timeframe:
- Choose the appropriate timeframe or specify another if needed.
*. Purpose or Reason for the Release:
- You can leave this blank for all lawful purposes, or specify a reason if you have one.
*. Signature Section:
- Sign and date the form.
- Have a witness sign and date the form.
- Indicate your relationship to the person whose information is being released (e.g., "Mother").
*. Revocation Clause:
- This consent may be revoked in writing at any time prior to any action taken in reliance upon it.
*. Expiration of Authorization:
- Specify an expiration date or event if desired. If not specified, it will expire 180 days from the date signed.
Would you like more guidance on any other part of the form?
*. Your Information:
- Last Name: HUGHEY
- First Name: MICHELLE
- Maiden Name or other names known by: MICHELLE SUZANNE MORIN
- Middle Name: SUZANNE
- Date of Birth: */*/*
- Social Security Number: *-*-*
*. Information to be Released From:
- Initial each applicable item. For your case, likely "KANSAS DCF" and possibly others if relevant.
*. Information to be Released To:
- Write your name, MICHELLE HUGHEY
- Initial each applicable item to indicate who will receive the information.
*. Information to be Released:
- Initial each item you want. For a comprehensive request, initial all items.
*. Timeframe:
- Choose the appropriate timeframe or specify another if needed.
*. Purpose or Reason for the Release:
- You can leave this blank for all lawful purposes, or specify a reason if you have one.
*. Signature Section:
- Sign and date the form.
- Have a witness sign and date the form.
- Indicate your relationship to the person whose information is being released (e.g., "Mother").
*. Revocation Clause:
- This consent may be revoked in writing at any time prior to any action taken in reliance upon it.
*. Expiration of Authorization:
- Specify an expiration date or event if desired. If not specified, it will expire 180 days from the date signed.
Would you like more guidance on any other part of the form?
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