Office of Recipient Rights

Dear Consumer, Service Provider, OCHN and Interested Parties: The OCHN Recipient Rights Office has revised the Authorization to Disclose Employee Information and Release of Liability form which enables you to verify whether employees that you have hired or are now considering for hire have any record of rights violations with this office. The process consists of requiring the following information on an employee: (i.e. full legal name including maiden name or previous name/s, last 4 digits of employee’s Social Security number, and their month and day of birth) which is consistent with State discussions regarding the development of a statewide perpetrator database. We have added the requirement for the Driver’s License or State Identification card number. The procedure is simple.  Please find enclosed with this letter the revised form that we must receive to release information to you. Please ensure your office has a sufficient supply of this form for future use.  Please complete a copy of the form with the employee. The employee must sign and date this document. The employee signature must also be witnessed, and the witness must also sign the document ensuring document is complete and legible to process. Forms being submitted must be current within three months of signature.  Fax (#248-858-1633), e-fax (#248-282-1754) or mail the form with the employee's signature to this Rights Office indicated on the bottom of the form.  Provider/Consumer address section must be completed to process. Upon receipt, this office will fax or send a copy of the form based on your preference back to you within ten business days of receipt with our indication as to whether the employee has substantiated rights violations with this office. As completing background checks are indicative of your commitment to hiring qualified staff, OCHN strongly encourages you to utilize this process. Similar processes are also available through the Rights Offices of CMH's in many of the surrounding counties. Please contact those offices directly for their forms. Additionally, you may want to check: Michigan Department of Corrections Offender Tracking Information System (OTIS) @ www.state.mi.us/mdoc/asp/otis2.html. If you have any questions, please contact me at (248) 858-1235 or at our above toll free number. Sincerely, Inspire Hope • Empower People • Strengthen Communities Vicki L. Suder Director, Rights and Advocacy 5505 Corporate Dr. | Troy, MI 48098 | Phone 248.858.1210 | Fax 248.452.9793 | www.oaklandchn.org

cc: Executive Director, OCHN Enclosure Revised 7/26/17 Inspire Hope • Empower People • Strengthen Communities 5505 Corporate Dr. | Troy, MI 48098 | Phone 248.858.1210 | Fax 248.858-1633 | www.oaklandchn.org