Date
Records
Custodian
_____________
Hospital
To Whom
It May Concern:
I hereby
give my permission for my attorney, ______________, or any
DeKalb County public defender or public defender’s investigator,
to have copies of my mental health records from this facility,
including but not limited to, any intake and discharge summaries
and diagnoses. I further give permission for the hospital
staff to discuss my case with Linda Pace or her successor
as my attorney.
__________________________
defendant’s
name and signature
___________________________
guardians
name and signature
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