• Management Referral

    Release of Information
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  • I understand that I am being referred to Human Development Company by my supervisor for concerns impacting the workplace. As a part of my work with Human Development Company, I understand that communication between my Supervisor and HDC are essential. I understand that communication between my affiliate counselor and HDC is also essential.

    Examples of the details that may be shared (but are not limited to) include:

    1. Scheduled appointments and attendance.

    2. Recommendations to supervisor regarding workplace resolution.

    3. Your compliance with the counselor’s recommendations.

    4. Your discharge summary.

     

    I authorize Human Development Company to release my information to:

  • I understand that this Release of Information will be valid from today’s date until six months from now. I understand I have the right to rescind this release at any time for any reason by calling 502-589-4357. I also understand that this referral is part of an effort to improve my job performance and/or workplace behaviors.

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