24-Hour Crisis Hotline: (877)SAFEGBC or (877)723-3422 Mental Health & Substance Abuse Issues

6502 Nursery Drive, Suite 100
Victoria, TX 77904
Fax: (361)578-5500
Regular Hours: M-Fri 8am - 5pm
Every 3rd Thurs of the Month - Extended Hours Until 7 pm


  • Gulf Bend Center must receive an authorization in writing to disclose information. Verbal authorizations are not acceptable.
  • If Gulf Bend asks for an authorization from an individual, the individual must be provided a copy of the authorization
  • Only the Center’s approved authorization form can be used to request information.
  • GBC can accept authorizations for information from others if it has all required components.
  • A valid authorization must include:
    • A meaningful description of information to be disclosed
    • The name of the entity to disclose the information
    • The name of person/entity to receive information
    • Purpose
    • An expiration date or event
    • Statement regarding individual’s right to revoke and description of how to revoke
    • A statement that if PHI is released to a non-covered entity, it will no longer be protecte
    • If authorization is signed by someone other than the consumer, the relationship and authority must be documented

Release of Information

Whenever a staff person discloses ANY information (outside the Center verbally or in writing) such disclosures must be documented in the consumer record.

What information is disclosed

  • What information is disclosed
  • To Whom 
  • Purpose

Document such disclosures in the progress note or on a log (get from medical records.)