Section 32-21-3-3.2 - Statement of Consent for DisclosureAll applicants, clients, or client representatives are to be informed of the confidentiality of records. Release of such information must be by written consent of the client or authorized representative and must include:
1. name and Social Security number of the client;2. designation of the parties to whom the information may be released;3. nature of the information to be released;4. specific purposes for which the released information may be used;5. designation of the Agency person authorized to disclose the information;6. dates of initiation and termination of consent; and,7. signature of the client and/or client representative.32 Miss. Code. R. 21-3-3.2