№ files_lp_3_process_7_045520
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This document is a formal consent and authorization form used by healthcare providers for review by the Local Human Rights Committee regarding objections to Authorized Representative appointments or decisions.
Year:
2023
Region / City:
United States
Topic:
Healthcare, Legal Representation
Document Type:
Form
Organization / Institution:
LHRC (Local Human Rights Committee)
Author:
Not specified
Target Audience:
Healthcare providers, Authorized Representatives, Legal guardians, LHRC
Effective Period:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
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Note:
Year
Year:
2026
Region:
Virginia, USA
Subject:
Human Rights Review Procedures
Document Type:
Instructional Guidance
Organization:
Local Human Rights Committee (LHRC)
Author:
Office of Human Rights
Target Audience:
Healthcare and social service providers
Legal Reference:
12VAC35-115-270; 12VAC35-115-146
Attachments Required:
Capacity Evaluation, Contact Information of Proposed Next Friend
Purpose:
Outline the process for requesting and conducting LHRC review for Next Friend designation
Year:
2026
Region:
Virginia, USA
Document Type:
Guidelines / Instructions
Authority:
Local Human Rights Committee (LHRC)
Regulation Reference:
12VAC35-115-270
Author:
Office of Human Rights
Target Audience:
Behavioral health service providers
Required Attachments:
Assessment by licensed professional, IRC approval, documentation of less restrictive alternatives
Plan Types Covered:
New, Quarterly Review, Revision
Confidentiality Measures:
Use of Individual Identifier, redaction of PII/PHI
Review Process:
LHRC acknowledgment, Executive Closed session if PHI involved
Year:
2023
Region / City:
Virginia, United States
Subject:
Human Research Review Process
Document Type:
Review Form
Organization:
Office of Human Rights (OHR)
Author:
OHR Regional Managers
Target Audience:
Providers, LHRC Members, Institutional Review Board (IRB) Members
Period of Action:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Year
Document Type:
Application
Institution / Organization:
Local Human Rights Committee
Target Audience:
Individuals applying to serve on a Local Human Rights Committee
Year:
2026
Region / City:
Virginia, USA
Subject:
Human Rights and Individual Restrictions
Document Type:
Guidance/Instruction Manual
Issuing Organization:
Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Author:
Office of Human Rights
Target Audience:
Service Providers, LHRC Members
Regulatory Reference:
12VAC35-115-50, 12VAC35-115-100, 12VAC35-115-270
Attachments:
LHRC Review Form, Written Notice Template, Documentation Requirements
Purpose:
Review and oversight of restrictions affecting dignity and freedoms of individuals receiving services
Compliance Requirements:
Documentation of restriction, prior assessment, individual notification, and regular review
Review Frequency:
As specified by LHRC and Human Rights Regulations
Contact Information:
Regional Human Rights Advocates by region; DBHDS website for meeting schedules
Year:
2015
Date:
November 2, 2015
Location:
Norfolk, Virginia, United States
Venue:
Norfolk Community Services Board, 225 W. Olney Road, Norfolk, VA
Document Type:
Meeting Minutes
Committee:
Health Planning Region V Local Human Rights Committee (LHRC)
Chair:
Adrienne Benjamin-Scott
Technical Advisor:
Stewart Prost, Office of Human Rights
Submitting Author:
Danora J. Brockman
Participating Organizations:
Community service providers and affiliated behavioral health and residential care organizations in Health Planning Region V
Primary Topics:
Affiliate reports, human rights oversight, abuse and neglect reporting, committee membership, service affiliation requests, administrative updates
Subject Area:
Behavioral health services oversight and human rights compliance
Audience:
Committee members, affiliated service providers, and regional human rights oversight bodies
Reporting Period Referenced:
May 2015 – November 2015 committee activity
Next Scheduled Meeting:
February 1, 2016
Related Reports:
Quarterly affiliate reports and CHRIS reports
Legal Reference:
Virginia Code § 2.2-371 (A)
Note:
Year
Organization / Institution:
U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation
Year:
2023
Region / City:
United States
Topic:
Medical authorization and billing
Document type:
Official form
Organization / Institution:
Department of Veterans Affairs
Author:
Department of Veterans Affairs
Target audience:
Healthcare providers, Veterans
Period of validity:
From date of issue
Date of approval:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / City:
Iowa, Des Moines
Subject:
Proposal Certification and Authorization to Release Information
Document Type:
Certification Letter
Issuing Organization:
Iowa Workforce Development
Author:
Michael Drottz
Target Audience:
Respondents to RFP 309MD24001
Period of Validity:
N/A
Approval Date:
N/A
Date of Revision:
N/A
Note:
Year
Organization / Institution:
Minnesota Department of Education
Target Audience:
School District Superintendents, Early Education Staff
Year:
2023
Region / City:
United States
Topic:
Personnel vetting, security clearance
Document Type:
Questionnaire, Authorization Form
Agency:
Federal Government
Author:
Unknown
Target Audience:
Individuals undergoing personnel vetting
Period of Validity:
Until termination of affiliation with the Federal Government or position requirement
Approval Date:
Not specified
Amendment Date:
Not specified
Document type:
Access authorization form
System:
Enterprise Income Verification (EIV)
Program area:
Multifamily Housing
Issuing organization:
U.S. Department of Housing and Urban Development
Legal basis:
Paperwork Reduction Act of 1995; Federal Privacy Act
OMB control number:
2502-0204
Purpose:
Initial or reinstated access to the Multifamily EIV system and acknowledgment of Rules of Behavior
Target users:
Multifamily Housing Coordinators and Contract Administrator Coordinators
Submission method:
Fax or email to HUD Multifamily Helpdesk
Access duration:
Up to one year before recertification
Security framework:
HUD Security Program Policy; HUD Handbook 2400.25 Rev. 1
Data sensitivity:
Personally identifiable information
Note:
Year
Theme:
Foster Care, Residential Care
Document Type:
Authorization Form
Organization / Institution:
Texas Department of Family and Protective Services (DFPS)
Target Audience:
Caregivers, Caseworkers
Year:
2026
Region / City:
N/A
Subject:
Prior authorization requirements for lower extremity endovascular procedures
Document type:
Checklist
Organization:
N/A
Author:
N/A
Target audience:
Healthcare providers
Period of validity:
N/A
Approval date:
N/A
Date of amendments:
N/A
Year:
2023
Region / City:
University of Kentucky
Subject:
Research Study Participation
Document Type:
Consent Form
Institution:
University of Kentucky
Author:
Research Team
Target Audience:
Potential research participants
Study Duration:
Variable (hours, days, months, years)
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2014
Region / City:
United States
Topic:
Medication Administration, Medical Authorization
Document Type:
Authorization Form
Organization / Institution:
245D licensed program
Author:
Not specified
Target Audience:
Individuals receiving medication assistance, legal representatives
Period of Validity:
Ongoing
Approval Date:
January 1, 2014
Date of Changes:
Not specified