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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Jackie Nitschke Center Inc
(920) 435-2093
700 Cherry Street
Green Bay, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Quality Addiction Management
(920) 337-6740
2979 Allied Street
Green Bay, WI
Services Provided
Substance abuse treatment, Methadone Maintenance, Methadone Detoxification
Types of Care
Outpatient

Data Provided by:
Lutheran Social Services
(920) 730-1321
3003 North Richmond Street
Appleton, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders, Criminal justice clients

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Family Counseling Services of Wausau
(715) 842-3346
903 2nd Street
Wausau, WI
Hotline
(715) 842-3346
Services Provided
Substance abuse treatment
Types of Care
Outpatient
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

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Wausau Health Services
(715) 845-3637
209 West Washington Street
Wausau, WI
Services Provided
Substance abuse treatment, Methadone Maintenance, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Pregnant/postpartum women, Women, Men, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired, Hmong, Spanish

Data Provided by:
Bellin Psychiatric Center
(920) 431-5533
301 East Saint Joseph Street
Green Bay, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Libertas Treatment Center
(920) 498-8600
1701 Dousman Street
Green Bay, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
Adolescents

Data Provided by:
Mooring Programs Inc
(920) 739-3235
607 West 7th Street
Appleton, WI
Services Provided
Halfway house

Data Provided by:
Dept of Veterans Affairs Alcohol/Drug
(608) 372-1758
500 East Veterans Street
Tomah, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days), Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Quality Addiction Management


Services Provided
Substance abuse treatment, Methadone Maintenance, Methadone Detoxification
Types of Care
Outpatient

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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