Consent: Rules about Obtaining Consent to Disclose Treatment Information Baraboo WI

Most general rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31). To be valid, a consent form must be in writing and must contain each of the items specified in §2.31.

Saint Clare Center
(608) 356-1533
1510 Jefferson Street
Baraboo, WI
Hotline
(800) 433-2688
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Residential short-term treatment (30 days or less), Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Seniors/older adults, Pregnant/postpartum women, Women, Men

Data Provided by:
Pauquette Center for
(608) 742-5518
2901 Hunters Trail
Portage, WI
Hotline
(608) 742-5344
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders, Criminal justice clients

Data Provided by:
Horizon House
(414) 342-3237
2511 West Vine Street
Milwaukee, WI
Services Provided
Substance abuse treatment
Types of Care
Residential long-term treatment (more than 30 days), Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Women

Data Provided by:
Matt Talbot Recovery Center
(414) 294-3050
3211 South Lake Drive
Saint Francis, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days)
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders

Data Provided by:
Affiliated Clinical Services Inc
(262) 338-2717
400 West River Drive
West Bend, WI
Services Provided
Substance abuse treatment, Detoxification, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders

Data Provided by:
Sauk County Dept of Human Services
(608) 355-4200
505 Broadway Street
Baraboo, WI
Hotline
(800) 533-5692
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired, Spanish

Data Provided by:
Pathway Clinic
(608) 643-3663
560 4th Street
Prairie Du Sac, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Memorial Hospital of Boscobel
(608) 375-6341
205 Parker Street
Boscobel, WI
Hotline
(866) 810-3433
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient

Data Provided by:
Kewaunee County Dept of Human Services
(920) 388-7030x270
810 Lincoln Street
Kewaunee, WI
Hotline
(920) 388-7030
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Alcocare Inc
(608) 754-2651
786 South Main Street
Janesville, WI
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days)
Special Programs/Groups
DUI/DWI offenders
Language Services
Spanish

Data Provided by:
Data Provided by:

Consent: Rules about Obtaining Consent to Disclose Treatment Information

Consent: Rules About Obtaining Consent To Disclose Treatment Information

The most frequently used exception to the regulations’ general rule prohibiting disclosure is client consent. (Parental consent must also be obtained in some States. See below.) The regulations’ requirements regarding consent are strict and somewhat unusual and must be carefully followed.

Most disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31). To be valid, a consent form must be in writing and must contain each of the items specified in §2.31:

1. The name or general description of the program(s) making the disclosure

2. The name or title of the individual or organization that will receive the disclosure

3. The name of the client who is the subject of the disclosure

4. The purpose or need for the disclosure

5. How much and what kind of information will be disclosed

6. A statement that the client may revoke (take back) the consent at any time, except to the extent that the program has already acted on it

7. The date, event, or condition upon which the consent will expire if not previously revoked

8. The signature of the client (and, in some States, his or her parent)

9. The date on which the consent is signed (§2.31(a)).

A general medical release form, or any consent form that does not contain all of the elements listed above, is not acceptable. (See the sample consent form in exhibit 3–1.) ...

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