Use an ROI form before sharing client information outside your practice
A release of information form, often called an ROI, gives a client a clear way to authorize disclosure of protected health information. For therapists, counselors, social workers, psychologists, psychiatrists, and other behavioral health professionals, this form is part of safe care coordination and responsible documentation.
A client may ask you to coordinate with a psychiatrist, primary care provider, school counselor, attorney, probation officer, parent, partner, employer, or insurance reviewer. Each request can involve different records, different limits, and different clinical risks. A signed ROI helps clarify what may be shared, who may receive it, why the information is being released, and when the authorization ends.
This article gives you a practical ROI template structure, sample wording, documentation tips, and common mistakes to avoid. It is written for behavioral health workflows, where psychotherapy notes, treatment summaries, diagnoses, medication coordination, and family involvement often require extra care.
What a release of information form does in behavioral health
An ROI form documents the client’s authorization for your practice to disclose specific health information to a named person or organization. It can also allow your practice to receive information from another provider, depending on how the form is written.
In mental health care, a release should be specific enough to protect client privacy while still supporting the purpose of the disclosure. “Send records to my doctor” may not be enough detail. A stronger authorization identifies the doctor, the information involved, the reason for the disclosure, and the expiration date or event.
Common behavioral health uses include:
- Coordinating care with a psychiatrist, primary care provider, or higher level of care program.
- Sharing a treatment summary with a school, attorney, case manager, or referring provider.
- Requesting prior records, discharge summaries, psychological testing, or medication history.
- Allowing limited communication with a family member, partner, guardian, or support person.
An ROI is not a substitute for clinical judgment. A client may authorize a disclosure, but the clinician still has to decide what is clinically appropriate, what is within the scope of the authorization, and whether another law or ethical rule applies.
Release of information form template for therapy practices
The following structure can be used as a starting point for an ROI form. Practices should adapt it to their policies, state requirements, payer expectations, and legal guidance. Behavioral health records can involve sensitive information, so vague language should be avoided.
1. Client identifying information
Start with enough information to identify the client accurately. This reduces the chance that the wrong record is released or that a request is delayed because staff cannot match the authorization to the correct chart.
- Client full legal name and any preferred name used in the chart.
- Date of birth.
- Phone number, email address, or mailing address.
- Client ID or record number, if your practice uses one.
For minors or clients with a legal representative, include the name and authority of the person signing. For example: parent, legal guardian, personal representative, health care proxy, or another legally recognized role.
2. Person or organization authorized to disclose information
The form should name the person or practice that may release information. In a solo practice, this may be the clinician’s name and practice name. In a group practice, it may be the legal entity or the treating provider, depending on your internal policy.
Sample wording:
I authorize [Practice Name / Provider Name] to disclose the information identified below.
3. Person or organization authorized to receive information
Be specific about the recipient. A complete ROI usually includes the recipient’s name, organization, address, phone number, fax number, secure email, or other delivery details. This is especially important when clients name a large hospital system, school district, law firm, or agency.
Sample wording:
Information may be disclosed to: [Name], [Organization], [Role], [Phone], [Fax/Secure Email], [Address].
4. Purpose of the disclosure
The purpose explains why the information is being shared. Common purposes include care coordination, referral, treatment planning, medication management, disability paperwork, legal request, school support, insurance review, or client request.
Use plain language. If the purpose is narrow, say so. For example, “coordination of medication management” is clearer than “healthcare purposes.”
5. Information authorized for release
This is one of the most important parts of the form. The client should be able to choose what information may be shared. Behavioral health records often include sensitive details that may not be needed for the recipient’s purpose.
- Diagnosis, dates of service, attendance, or treatment status.
- Treatment plan, progress summaries, discharge summary, or referral information.
- Medication history, risk assessment information, or care coordination notes.
- Testing results, intake assessment, or other specified records.
Many practices avoid sending entire records unless necessary. A concise treatment summary may meet the request while reducing unnecessary disclosure.
6. Sensitive information categories
Some types of information may require specific authorization depending on the setting, state law, and the type of record. Examples may include substance use treatment information, HIV-related information, genetic information, reproductive health information, or psychotherapy notes. Behavioral health practices should review their forms with qualified legal or compliance support before using broad checkboxes for sensitive categories.
Sample wording:
This authorization includes only the categories checked below. Information not checked is not authorized for disclosure unless otherwise required or permitted by law.
7. Method of disclosure
The form should identify how information may be sent. Options may include secure portal, secure email, fax, mail, phone consultation, or in-person pickup. If your practice permits verbal communication only, state that clearly.
For example, a client may authorize you to speak with a psychiatrist but not send written records. Another client may authorize a written treatment summary but not ongoing phone contact. The form should make those limits easy to document.
8. Expiration date or expiration event
An ROI should state when the authorization ends. Some practices use a fixed date. Others use an event, such as “completion of care coordination for this referral” or “end of the current school year.” The right approach depends on the purpose of the disclosure and applicable requirements.
Sample wording:
This authorization expires on [date] or when [event] occurs, unless revoked earlier in writing.
9. Client rights and revocation language
The form should explain that the client may revoke the authorization, usually in writing, and that revocation does not undo disclosures already made in reliance on the authorization. Use language that fits your practice policy and legal requirements.
Make revocation operationally clear. If a client revokes an ROI, your team should know where to document it, who to notify, and how to prevent future disclosures under the revoked authorization.
10. Signature and date
The form needs a signature line, printed name, date, and relationship to the client if the signer is not the client. If electronic signatures are used, the practice should confirm that its process meets applicable legal and organizational requirements.
For telehealth practices, it also helps to define how signed releases are collected, stored, and verified before information is shared.
Copyable release of information form example
Use this example as a drafting aid, not as legal advice. Your final form should be reviewed for your practice type, state, client population, and record systems.
Authorization for Release of Information
Client Name: ___________________________ Date of Birth: ___________________________
Address / Phone / Email: __________________________________________________________
I authorize [Practice Name / Provider Name] to disclose and/or obtain information involving my care as described below.
Information may be disclosed to or obtained from:
Name: ___________________________ Organization: ___________________________
Role: ___________________________ Phone/Fax/Secure Email: ___________________________
Address: __________________________________________________________________________
Purpose of disclosure:
- Care coordination or treatment planning.
- Medication management or medical consultation.
- Referral, discharge planning, or continuity of care.
- Other: ___________________________________________
Information authorized for release:
- Dates of service, attendance, diagnosis, or treatment status.
- Treatment plan, progress summary, intake assessment, or discharge summary.
- Medication information, risk-related information, or care coordination details.
- Other specific records: ___________________________________________
Limits or exclusions: ______________________________________________________________
Method of disclosure: Phone consultation / secure email / fax / mail / portal / other: ____________
Expiration: This authorization expires on ____________ or upon this event: ____________________
I understand that I may revoke this authorization in writing, except to the extent that action has already been taken based on it. I understand that information disclosed under this authorization may be subject to redisclosure by the recipient, depending on applicable law and the recipient’s privacy obligations.
Client or Representative Signature: ___________________________ Date: ____________
Printed Name: ___________________________ Relationship to Client: ________________
Example scenario: coordinating therapy and psychiatry
A client in individual therapy reports worsening panic symptoms and wants to consult with a psychiatrist about medication options. The therapist recommends coordination so the psychiatrist understands the current treatment focus, symptom history, risk factors, and client preferences.
A narrow, useful ROI might authorize the therapist to speak with the psychiatrist and send a brief treatment summary. The form could name the psychiatrist, list “care coordination and medication consultation” as the purpose, and permit disclosure of diagnosis, current symptoms, treatment goals, relevant risk history, and current interventions.
The therapist would not automatically send every progress note. If the psychiatrist only needs a summary, the clinician can disclose the minimum information appropriate for the purpose and document what was sent, when it was sent, and why it was clinically relevant.
Common ROI mistakes that slow down care coordination
Most ROI problems are not dramatic. They are small omissions that create delays, extra messages, or uncertainty about what can be shared. A form may be signed but still unusable if it does not name the recipient, identify the records, or include an expiration date.
- Using broad recipient names: “My doctor” or “the school” may not identify a specific person or department.
- Leaving record types unclear: “Any information” can be too broad for sensitive behavioral health records.
- Forgetting the expiration: Staff need to know whether the authorization is still active before responding.
- Not documenting revocation: A revoked ROI should be easy to see in the client’s record.
Another common issue is assuming one ROI covers every future situation. A client may authorize communication with a primary care provider for medication coordination but not authorize disclosure to an attorney, employer, or family member. New purpose, new recipient, or new record type often means the authorization should be reviewed.
How to document ROI activity in the clinical record
The ROI form is only one part of the documentation trail. The clinical record should also show what happened after the authorization was signed. This helps the next clinician, supervisor, billing team, or records coordinator understand the status without guessing.
A brief administrative or care coordination note may include:
- Date the ROI was signed and the person or organization named.
- Information sent, received, or discussed.
- Method of communication, such as secure fax, portal, mail, or phone call.
- Follow-up needed, including pending records or planned consultation.
For example: Client signed ROI authorizing coordination with Dr. Lee for medication consultation. Therapist sent treatment summary by secure fax on 04/18/2026 and documented fax confirmation. Awaiting psychiatric evaluation summary.
This type of note is short, but it protects continuity. It shows that the disclosure was tied to an authorization and gives future staff enough detail to avoid duplicate requests.
ROI workflow checklist for private practices and small groups
A consistent ROI workflow reduces back-and-forth between clinicians, clients, and administrative staff. It also helps solo clinicians avoid relying on memory after a full day of sessions.
- Confirm the purpose of the request before sending the form.
- Use a form that names the sender, recipient, record types, method, and expiration.
- Review the signed ROI for missing fields before disclosing information.
- Document the disclosure, receipt of records, phone consultation, or revocation in the chart.
For group practices, assign ownership. Decide who reviews completed ROIs, who sends records, who tracks expiration dates, and who updates the clinician when outside records arrive. Without clear roles, ROI tasks can sit between clinical and administrative teams.
Using AI-assisted documentation without losing clinician control
AI should not decide whether information may be released. That decision belongs to the clinician and the practice’s privacy process. AI-assisted documentation can still help with the surrounding work: drafting care coordination notes, organizing session details, summarizing clinically relevant information, and keeping documentation consistent.
AutoNotes is built for behavioral health documentation, including progress notes, intake notes, assessments, treatment plans, and other structured clinical drafts. A clinician can enter relevant details from a session or care coordination task, then review and edit the draft before placing it in the clinical record.
For ROI-related workflows, AutoNotes can help clinicians create clearer documentation around:
- Client requests to coordinate care with another provider.
- Phone consultations with psychiatrists, case managers, or school staff.
- Treatment summaries based on clinician-selected information.
- Follow-up plans after receiving outside records.
The clinician remains responsible for reviewing the draft, checking accuracy, and finalizing the note. This matters in behavioral health, where wording can affect privacy, risk documentation, treatment planning, and the therapeutic relationship.
Where an ROI fits with progress notes, SOAP notes, and DAP notes
An ROI form is not a progress note. It is an authorization document. Still, ROI activity often affects clinical documentation because outside communication can influence assessment, interventions, referrals, and treatment planning.
In a SOAP note, ROI-related content may appear in the Plan section if the client agrees to coordinate with a psychiatrist or physician. If outside records are received, clinically relevant information may also affect the Subjective, Objective, or Assessment sections depending on the content.
In a DAP note, ROI details often fit in the Plan section: Client signed ROI for therapist to coordinate with school counselor regarding attendance concerns. Therapist will send brief summary after client reviews preferred scope of disclosure.
The key is separation. Keep the signed ROI as the authorization record. Use the progress note to document clinically relevant decisions, care coordination, client preferences, and follow-up.
Privacy and review steps before releasing records
Before disclosing information, pause long enough to confirm that the signed authorization matches the request. This is especially important when the request comes from a third party rather than the client.
A practical review can include four questions:
- Does the ROI name this recipient clearly?
- Does the ROI authorize this type of information?
- Is the ROI still active and not revoked?
- Is the disclosure clinically appropriate and limited to the stated purpose?
If any answer is unclear, clarify before sending records. A short delay is usually better than releasing information beyond the client’s authorization or sending records the recipient does not need.
FAQs about release of information forms
Do therapists need an ROI to talk to another provider?
Often, yes. If you are disclosing protected client information to another provider, a signed ROI is commonly used to document the client’s permission. Some situations may have special rules or exceptions, so practices should follow applicable law, ethics standards, and internal policy.
Can a client authorize verbal communication only?
Yes, an ROI can be written to allow phone consultation or verbal care coordination without authorizing written records. The form should state the permitted method clearly.
How long should an ROI last?
The expiration should match the purpose. Some authorizations use a specific date, while others use an event such as completion of a referral or end of a school year. Avoid leaving the duration unclear.
Can a client revoke a release of information?
Clients can generally revoke an authorization, usually in writing. The practice should document the revocation and stop future disclosures under that ROI, except where action has already been taken based on the authorization.
Should psychotherapy notes be included in an ROI?
Psychotherapy notes are often treated differently from other clinical records. If a request involves psychotherapy notes, use extra care and seek guidance before disclosure. Many care coordination needs can be met with a treatment summary instead.
Can electronic signatures be used for ROI forms?
Many practices use electronic signatures, but the process should meet applicable legal and organizational requirements. The signed form should be stored in a way that staff can find and verify before information is released.
What should I document after sending records?
Document the date, recipient, information disclosed, method used, and any follow-up needed. If you sent a treatment summary or spoke with another provider, summarize the clinically relevant points in the chart.
Can AutoNotes create the signed ROI form for my practice?
AutoNotes is focused on AI-assisted clinical documentation drafts for behavioral health workflows. It can help draft related notes, treatment summaries, care coordination documentation, and follow-up plans, but your practice should use approved ROI forms and review all authorization requirements before releasing information.
Build a cleaner documentation process around ROI requests
A good release of information form protects client choice, supports care coordination, and gives your practice a clear record of what was authorized. The best forms are specific: they name the recipient, state the purpose, identify the records, define the method, and include an expiration.
AutoNotes helps behavioral health professionals create structured, editable documentation drafts faster, including progress notes, treatment plans, assessments, and care coordination notes. If ROI-related tasks are adding to your after-hours paperwork, AI-assisted drafts can give you a clearer starting point while keeping you in control of review and final wording.
Start your free trial to see how AutoNotes can help you spend less time drafting clinical documentation and more time focused on client care.
