The release of information document must include the following:
  (1) name of no more than one person or organization to which the information is being released;
  (2) specific information to be released;
  (3) beginning and ending dates the release is effective, not to exceed the resident's stay or the nonresident's active length of services;
  (4) date and the signatures of the resident or nonresident and the employee or volunteer; and
  (5) right to revoke a release of information at any time. This revocation request must be submitted in writing.

Source Note: The provisions of this §356.621 adopted to be effective December 23, 2007, 32 TexReg 9328; amended to be effective September 1, 2013, 38 TexReg 4309; transferred effective April 1, 2024, as published in the March 8, 2024, issue of the Texas Register, 49 TexReg 1507