California Code, Welfare and Institutions Code - WIC § 4515

Signed consent forms by a person with a developmental disability or, where appropriate, the parent, guardian, or conservator, for release of any information to which such person consents under the provision of Sections 11878 or 11879 of the Health and Safety Code, or subdivision (a) or (d) of Section 4514 shall be obtained for each separate use with the use specified, the information to be released, the name of the agency or individual to whom information will be released indicated on the form and the name of the responsible individual who has authorization to release information specified.  Any use of this form shall be noted in the file of the person with developmental disabilities.  Persons who sign consent forms shall be given a copy of the consent forms signed.