Please completely fill in ALL areas to include the following: • Patient Information: Patient Name, Patient Date of Birth and Phone. Number. Housing Deposits authorization letters notify clients of eligibility to use funds for costs tied to a move-in.Print and complete the Alameda County Behavioral Authorization to Disclosure Psychotherapy Notes form: English (PDF) Alameda County Information Sharing Authorization. Authorization for Sharing Your Protected Health and Personal Information. Alliance has up to 30 calendar days to process retro requests. Modification Request for existing authorized services. Fill out – on this page, then file it with the small claims clerk at or before the trial. If you do not have network access please fill out a Network Access form. Click here more information.