Consent: Rules about Obtaining Consent to Disclose Treatment Information Fond Du Lac 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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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 Agnes Hospital
(920) 926-4290
430 East Division Street
Fond Du Lac, WI
Hotline
(920) 926-4290
Services Provided
Substance abuse treatment, Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days), Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Seniors/older adults, Pregnant/postpartum women, Women, Men, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Fond Du Lac County
(920) 929-3500
459 East 1st Street
Fond Du Lac, WI
Hotline
(920) 929-3535
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
Adolescents
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Affiliated Counseling Center LLC
(920) 922-7440
17 Forest Avenue
Fond du Lac, WI
Hotline
(920) 576-8866
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

Data Provided by:
Nova Counseling Services Inc
(920) 231-0143
3240 Jackson Street
Oshkosh, 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), Outpatient
Special Programs/Groups
Women, Men

Data Provided by:
Red Cliff Tribe
(715) 779-3741
North Braddum Road off Blueberry Road
Bayfield, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential long-term treatment (more than 30 days), Outpatient

Data Provided by:
Beacon House
(920) 923-3999
166 South Park Avenue
Fond Du Lac, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Women, Residential beds for clients' children

Data Provided by:
Blandine House Inc
(920) 922-9487
25 North Park Avenue
Fond Du Lac, WI
Services Provided
Substance abuse treatment
Types of Care
Residential long-term treatment (more than 30 days)
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
ARC Community Services Inc
(920) 907-0813
17 Forast Avenue
Fond Du Lac, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Pregnant/postpartum women, Women, Criminal justice clients

Data Provided by:
Quality Addiction Management (QAM)
(262) 549-6600
2422 North Grandview Boulevard
Waukesha, WI
Services Provided
Substance abuse treatment, Methadone Maintenance, Methadone Detoxification
Types of Care
Outpatient

Data Provided by:
Genesis Behavioral Services Inc
(414) 442-5990
2436 North 50th Street
Milwaukee, 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)
Special Programs/Groups
Men, Criminal justice clients

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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