Consent: Rules about Obtaining Consent to Disclose Treatment Information Prescott Valley AZ

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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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.

West Yavapai Guidance Clinic
(928) 445-5211x299
642 Dameron Drive
Prescott, AZ
Services Provided
Substance abuse , Detoxification
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
Pregnant/postpartum women, Women, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired, Hopi, Navajo, Spanish

Data Provided by:
Decision Point Center Inc
(928) 778-4600
505 West Whipple Street
Prescott, AZ
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days), Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Women, Men

Data Provided by:
Veterans Affairs Medical Center
(928) 445-4860
500 Highway 89 North
Prescott, AZ
Services Provided
Substance abuse , Detoxification
Types of Care
Residential long-term treatment (more than 30 days), Outpatient, Partial hospitalization/day treatment
Language Services
ASL or other assistance for hearing impaired, Spanish

Data Provided by:
Wick Home for Emotional Growth and
(928) 639-9425
2101 East Fir Street
Cottonwood, AZ
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Adolescents

Data Provided by:
Flagstaff Medical Center
(928) 213-6400x16400
1200 North Beaver Street
Flagstaff, AZ
Services Provided
Substance abuse , Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders

Data Provided by:
Pia''s Place
(928) 445-5081
615 Hillside Avenue
Prescott, AZ
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women

Data Provided by:
Prescott House Inc
(928) 776-8251
214 North Arizona Avenue
Prescott, AZ
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days), Outpatient

Data Provided by:
Verde Valley Guidance Clinic Inc
(928) 634-2236
8 East Cottonwood Street
Cottonwood, AZ
Hotline
(928) 634-2236
Services Provided
Substance abuse , Detoxification, Buprenorphine Services
Types of Care
Residential long-term treatment (more than 30 days), Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, DUI/DWI offenders

Data Provided by:
Terros Inc
(602) 685-6000
3864 North 27th Avenue
Phoenix, AZ
Services Provided
Substance abuse , Detoxification
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired, Arabic, Spanish

Data Provided by:
Terros Inc
(602) 685-6000
3118 East McDowell Road
Phoenix, AZ
Services Provided
Substance abuse , Detoxification
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired, Arabic, 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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