Forms

Please fill out each form in the section you have been instructed to complete.

Forensic Interview: (Caregiver)

• KPCAC Consent & Authorization Form
• KPCAC COVID-19 WAIVER with minor children
• Department of Victim Compensation
• Victim’s Bill of Rights
• Release of Information

Forensic Interview: (MDT Partner)

• DSS & LE Forensic Interview Request
• KPCAC COVID-19 WAIVER

Therapeutic Service:

• KPCAC Consent & Authorization Form
• Telehealth Addendum
• Release of Information

PSB Ages 13 to 18

• KPCAC Consent & Authorization Form
• Telehealth Addendum
• SBP Authorization-Consent
• Limits of Confidentiality
• Release of Information

PSB Ages 7 to 12

• KPCAC Consent & Authorization Form
• Telehealth Addendum
• PSB-S Authorization-Consent
• Release of Information

PSB Ages 6 and younger

• KPCAC Consent & Authorization Form
• Telehealth Addendum
• SBP-P Authorization-Consent
• Release of Information

Specialized Staffing

• CSEC MDT Staffing Authorization Form

Forensic Medical Paperwork:

• MUSC Health, Ambulatory, and Telehealth Consent for Medical Treatment

Additional Forms:

• KPCAC COVID-19 WAIVER with minor children
• Release of Information
• Group Telehealth Services Confidentiality Agreement
• KPCAC Holiday Program

Formularios en Español

• Consentimiento y Autorización para Revelar/Recibir Información con Fines de Administración de Casos e Investigación
• Revocación de Consentimiento y autorización para revelación de información o MOA (memorando de acuerdo)
• Consentimiento para la Revelación de Información Confidencial
• Adenda al Consentimiento Informado Para Terapia en Línea