Renaissance Ranch Ogden Consent to Service

  • I authorize Renaissance Ranch to provide addiction treatment services according to the rules and regulations of Renaissance Ranch. These services will be coordinated between the client and the appropriate Renaissance Ranch Staff
     
    I consent to possible searches of my personal belongings by authorized staff whenever conducted, announced or unannounced. I further agree to participate in blood, urine, breathalyzer or other alcohol, or drug testing whenever asked by authorized staff.
     
    I am also giving permission in the event of an emergency for Renaissance Ranch staff; to administer first aid or CPR and/or be transferred to the nearest hospital in the event of a medical emergency. I also agree to not hold Renaissance Ranch or its staff responsible for any injury or ham that may occur doe to first aid/CPR actions.
     
    The following notice will Accompany Any Disclosure

     
    This information has been disclosed to you from records protected by Federal Confidentiality rules (42 CFR part 2) The Federal rule prohibits you of making any further disclosure of this information unless further disclosure is expressly permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute an alcohol or drug patient.
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