Required Forms for Lumiere Du Coeur Habilitation Center
Welcome! Below are the forms you need to complete as part of your care with us. Click on the links to access and fill out the appropriate form.
HIPAA Authorization to Use/Disclose PHI (ROI)
Fill Out Form HereThis form allows you to authorize the release of your Protected Health Information (PHI) to other healthcare providers, family members, or insurance companies. Please note that this form does not include psychotherapy notes.
Psychotherapy Notes Authorization
Fill Out Form HereThis form is specifically for authorizing the release of psychotherapy notes, which are separate from your regular medical records.
Notice of Privacy Practices (NPP) Acknowledgment
Fill Out Form HereThis form acknowledges that you have received or had the opportunity to review our Notice of Privacy Practices (NPP), which explains how your health information is used and protected.