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[quote=Anonymous]The government doesn’t have unfettered access to your medical records. There are questions on the SF-86 asking about mental health issues and alcohol/drug issues. The information you provide there can lead to the government speaking to your care provider. And yes, you absolutely signed a consent form if you have been evaluated for a clearance. Investigators have a series of questions that they can ask care providers.

Here is a good overview:

[i]The SF-86 asks applicants several questions that relate to psychiatric treatment. The first question asks applicants to indicate whether they have consulted with a mental health professional within the last 7 years and, if so, to disclose the dates of treatment, and the name and address of the physician or therapist. However, the disclosure of treatment dates and the contact information is not required if the “consultation(s) involved only marital, family, or grief counseling, not related to violence by you.” In another section, the applicant is asked if their use of alcohol has resulted in any alcohol-related treatment or counseling in the last 7 years. Again, if the applicant replies affirmatively, they must supply the dates of treatment, identity of the physician or counselor, and related contact information.

The SF-86 includes an “Authorization for Release of Medical Information”. This authorization allows the investigator to obtain responses to three questions concerning “mental health consultations.” The form indicates to applicants, “Your signature will allow the practitioner(s) to answer only these questions.” The three questions are: (1) Does the person under investigation have a condition or treatment that could impair his/her judgment or reliability, particularly in the context of safeguarding classified national security information or special nuclear information or material? (2) If so, please describe the nature of the condition and the extent and duration of the impairment or treatment, (3) What is the prognosis?

At the time of the in-person interview with the investigator, upon verification of past or current mental health treatment, the clearance applicant is asked to sign a second release, Specific Release OFI-16A. The OFI-16A authorizes the federal investigator to obtain information from clinicians or organizations identified by the applicant. This form provides two boxes that the applicant can check to specify the information to be released. The first, headed “Medical,” states, parenthetically, “May include, but not limited to: dates of confinement, participation, or treatment; diagnosis; doctors’ orders; medication sheets; urine result reports; prognosis; and medical opinions regarding my health, recovery and/or rehabilitation; as well as other information indicated below,” followed by lines to be filled in by the applicant. At the end of the lines appears the statement, “I am aware that the information released by the above named person or organization may, but not necessarily, contain data pertaining to my use and/or abuse of alcohol and/or drugs, and my participation in a rehabilitation program with the above named organization.” The second box, headed “Other,” provides several lines for information to be specified.

The standard investigator practice is to arrange to meet with the applicant-identified psychiatrist and to present the signed OFI-16A. The SF-86 release is not routinely presented, except in unusual circumstances: for example, when the investigator interviews the psychiatrist prior to the applicant interview and, therefore, an OFI-16A has not been executed. The OFI-16A is the preferred release form.

The Office of Personnel Management provides an investigator’s handbook that provides a set of questions about applicants, to be answered by the identified psychiatrists. These questions are as follows:
1. Dates of treatment;
2. The initial complaint/reason why treatment was sought;
3. The identity and amount of any medication prescribed;
4. The nature of any additional treatment provided or
recommended;
5. Whether the Subject followed all prescribed or recommended
6. The exact nature of any diagnoses made;
7. Whether and to whom the Subject was referred and whether and
from whom the Subject was referred; 8. The prognosis;
9. The potential for the Subject’s condition or treatment to impact on their ability to properly safeguard sensitive (in public trust cases) or classified (in national security cases) information;
10. The potential for the Subject’s condition or treatment to impact their judgment or reliability; and
11. Whether Subject has or may engage in any violent or otherwise reckless or aberrant behavior because of their condition or treatment.

Adjudicators review all information compiled during the course of the investigation and determine whether clearance will be granted. In some cases, adjudicators may require that specialized evaluations be performed to assess security risk. A positive response from the treating psychiatrist to questions 9, 10, or 11 indicating that the person under investigation has a condition that could affect their ability to safeguard information, impair judgment or reliability, or is at risk for violent or aberrant behavior, is likely to trigger a request for more information and a specialized mental health evaluation. 
Specialized mental health evaluations also result when treating psychiatrists are unable to address those questions, or indicate that they have “no opinion.” Reportedly, the majority of applicants with psychiatric treatment histories, and the majority of those who have specialized evaluations, receive security clearances. In some instances, clearance may be made contingent upon continued psychiatric treatment.[/i]

https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/rd2006_FederalPersonnelInvestigations.pdf
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