Authorization for Release of Information

700.10 Purpose of the DDPAS-7

The purpose of the DDPAS-7 is to ensure the confidentiality of documents and communications of individuals with developmental disabilities. This section also describes the procedures for completing the DDPAS-7. All requirements in this chapter shall be guided by and in conformity with the Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110). 

700.20 Documentation Requirements

In order for the PAS agency to initiate the PAS process, the individual to be assessed or the legal guardian must sign and date the DDPAS-7. The PAS agency shall maintain a copy of the signed and dated DDPAS-7 at the agency.

The DDPAS 7 must document the following information:

  1. Name of the individual for whom the information is being sought and the individual's Social Security number.
  2. Name and mailing address of the person or service agency to whom the disclosure is to be made.
  3. Relevant and specific information to be disclosed.
  4. Purpose for which the disclosure is to be made.
  5. Signature of the authorized person (individual with developmental disability who is at least 18 years of age or legal guardian).
  6. Relationship of the signer, if the signer is not the person for whom the information is being sought.
  7. Signature of the witness who can attest to the identity of the authorized person
  8. Date the consent expires

All refusals to sign and date the DDPAS-7 shall be documented by the PAS agency. Should this occur, the PAS agency will:

  1. Discuss with the individuals their reasons for refusing to sign and date DDPAS-7.
  2. Remind the individuals or legal guardians that without the necessary assessments, the PAS agency will not be able to identify needed support services or link the individual to such services.
  3. Document all action taken to resolve and/or honor the refusal.

Individuals who, for physical reasons, are unable to sign their names to the DDPAS-7, but are able to indicate their own consent shall have such information noted on the assessment form. The individual may write an "X" on the signature line, if physically able. If the individual is unable to sign or if the individual is able only to write an "X," the following enhanced documentation of consent must be provided:

  1. The person's name must be affixed to the DDPAS-7 signature line by the PAS agency on behalf of the individual, with an explanation ("Signed at the request of and in the presence of (individual's name) by (PAS QIDP's name).
  2. Witnessed by a third person unaffiliated with the PAS agency.

A signed and dated DDPAS-7 shall be considered valid until any of the following conditions occurs:

  1. A period of 12 months has elapsed from the date of signature authorizing consent.
  2. The date of expiration on the DDPAS-7 has passed.
  3. The consent represented by the DDPAS-7 has been revoked by the individual or legal guardian.

A blanket consent for the disclosure of unspecified information is invalid.

Advance consent may be valid only if the nature of the information to be disclosed is specified in detail and the duration of the consent is indicated.

Official documentation regarding the authorized person's "legal relationship to the individual" or "legal basis" must be present in the individual's record.

No person or service agency to whom any information is disclosed may redisclose such information unless the person who consented to the disclosure specifically consents to such redisclosure.

The DDPAS-7 may be revoked in writing by the individual or guardian at any time without reason provided. Any such revocation has no effect on disclosure made prior thereto. No written revocation of consent shall be effective to prevent disclosure of records and communications until it is received by the person otherwise authorized to disclose records and communications.