Consent: Rules about Obtaining Consent to Disclose Treatment Information Burlington 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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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.

Oakwood Clinical Associates
(262) 652-9830
24726 75th Street
Paddock Lake, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women, Men, DUI/DWI offenders

Data Provided by:
Behavioral Medicine Center
(262) 928-4068
240 Maple Avenue
Mukwonago, WI
Hotline
(262) 928-4036
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Seniors/older adults, Women
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Saint Joseph''s Hospital
(800) 468-9700
611 Saint Joseph Avenue
Marshfield, WI
Hotline
(800) 468-9700
Services Provided
Substance abuse treatment, Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, Men, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Multi Cultural Counseling Services
(414) 383-4455
1225 West Mitchell Street
Milwaukee, WI
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders, Criminal justice clients

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:
Aro Counseling Centers Inc
(262) 723-1455
797 East Geneva Street
Elkhorn, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Menominee Cnty Hlth Human Servs Dept
(715) 799-3861
W3272 Wolf River Road
Keshena, WI
Hotline
(715) 799-3861
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Appleton Psychiatric/Counseling Center
(920) 882-6610
477 South Nicolet Road
Appleton, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders

Data Provided by:
Koller Behavioral Health Services
(715) 356-8540
311 Elm Street
Woodruff, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Eau Claire Academy
(715) 834-6681
550 North Dewey Street
Eau Claire, WI
Services Provided
Substance abuse treatment
Types of Care
Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days), Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders

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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