Application for Treatment

• I hereby give permission for all care professionals with whom I have been involved to release to Bosence any relevant information which may be required.
• Bosence may release to my Local/Health Authority such details as may be required to apply for funding.
• Bosence may submit anonymous information to the National Drug Treatment Monitoring System (NDTMS) in accordance with OHID guidelines.
• I acknowledge that this information will be stored on the Bosence database and/or internal electronic systems.
• On my discharge I accept that reports will be sent to all care professionals involved in my care to support my continuing recovery
• I hereby give permission for Bosence to share my contact details including telephone number and email, to be provided to the Care Quality Commission on request for inspection purposes.
• I acknowledge that confidentiality is held within the Bosence treatment team and not with a lone individual.
• I acknowledge that this signature is part of the identification required for any future requests for release of information to me.