Difference between revisions of "Josh release form"
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[[category:Josh]][[Josh]]: [[Josh release form|release form]] | [[category:Josh]][[Josh]]: [[Josh release form|release form]] | ||
==Release Form== | ==Release Form== | ||
' | The following entities and their agents have our permission to discuss details of Josh A Smith's case with each other, effective today – {{CURRENTMONTHNAME}} {{CURRENTDAY}}, {{CURRENTYEAR}} – and good for 60 days from this date: | ||
* [[htyp:Caring Hands & Supplementary Enrichment Education|Caring Hands & Supplementary Enrichment Education]] | * [[htyp:Caring Hands & Supplementary Enrichment Education|Caring Hands & Supplementary Enrichment Education]] | ||
* [[htyp:Community Partnerships|Community Partnerships]] | * [[htyp:Community Partnerships|Community Partnerships]] | ||
* [http://www.healthgrades.com/health-professionals-directory/David-Caron-1DBA26CB/map-directions David G. Caron] (of Chapel Hill, NC) | |||
* Durham County Government Department of Social Services | * Durham County Government Department of Social Services | ||
* [[htyp:Durham Public Schools|Durham Public Schools]] | * [[htyp:Durham Public Schools|Durham Public Schools]] | ||
* TEACCH | * TEACCH | ||
* The Autism Society of North Carolina | * The Autism Society of North Carolina | ||
* [[ | * [[The Durham Center]] | ||
* The Arc of Durham County | * [[The Arc of Durham]] County | ||
* The Arc of North Carolina | * [[The Arc of North Carolina]] | ||
* Triangle Neuropsychiatry | * Triangle Neuropsychiatry | ||
* [[htyp:Matchbox Health Services|Matchbox Health Services]] | * [[htyp:Matchbox Health Services|Matchbox Health Services]] | ||
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[[Image:SLH Josh release form signature.jpg|400px]] | [[Image:SLH Josh release form signature.jpg|400px]] | ||
==Validity== | |||
Note that this page, unlike most other pages in the wiki, is protected against editing by untrusted visitors. If you are on the above list and have concerns about the validity of this release, we will be happy to send you a signed physical copy of it or of your preferred release form. | |||
Latest revision as of 19:20, 4 March 2010
Release Form
The following entities and their agents have our permission to discuss details of Josh A Smith's case with each other, effective today – November 22, 2024 – and good for 60 days from this date:
- Caring Hands & Supplementary Enrichment Education
- Community Partnerships
- David G. Caron (of Chapel Hill, NC)
- Durham County Government Department of Social Services
- Durham Public Schools
- TEACCH
- The Autism Society of North Carolina
- The Durham Center
- The Arc of Durham County
- The Arc of North Carolina
- Triangle Neuropsychiatry
- Matchbox Health Services
- Maxim Healthcare Services
Validity
Note that this page, unlike most other pages in the wiki, is protected against editing by untrusted visitors. If you are on the above list and have concerns about the validity of this release, we will be happy to send you a signed physical copy of it or of your preferred release form.