The duration of this authorization is for one year after the termination of my case. I understand that I may revoke this consent at any time by notifying the facility in writing or orally, except to the extent that action has already been taken in reliance on my consent. A photocopy of this authorization is to be considered as valid as the original document.
I understand that organizations and individuals that are not listed above may be contacted, but that only my general situation and no personal information will be shared with these entities unless I am applying to receive financial assistance of any kind. If I am applying for financial assistance, I understand that CRCTV may need to speak to relevant agencies and individuals to seek out what resources might be available, to assess which community resources have already been used by me, and to inform those resources of the use of CRCTV funds to prevent duplication of services.
I understand that assistance rendered may not be solely monetary and authorize advocacy on my behalf. I understand that a committee makes the decision as to any assistance that I may receive from CRCTV and CRCTV intake agents do not have authority to, or capacity of, making immediate assistance available.