Consent Form


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to IntAc – Intensive Case Management Access Coordination (Canadian Mental Health Association – Hamilton Branch, Community Mental Health Promotion Program – City of Hamilton, Hamilton Program for Schizophrenia, and Hamilton Mental Health Outreach)
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I understand the purpose for disclosing this personal health information to the agencies noted above is to determine my eligibility for case management services. I understand that I can refuse to sign this consent form.
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