Consent: Rules about Obtaining Consent to Disclose Treatment Information Salem NH

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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Health and Education Services Inc
(978) 683-3128
30 General Street
Lawrence, MA
Hotline
(978) 620-1250
Services Provided
Substance abuse
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders
Language Services
Spanish

Data Provided by:
Health and Education Services Inc
(978) 373-1126
60 Merrimack Street
Haverhill, MA
Services Provided
Substance abuse , Buprenorphine Services
Types of Care
Outpatient
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Quitting Time At Hampstead Hospital
(603) 329-5833
218 East Road
Hampstead, NH
Services Provided
Substance abuse
Types of Care
Outpatient

Data Provided by:
Psychological Center
(978) 685-1337
11 Union Street
Lawrence, MA
Services Provided
Substance abuse
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women, DUI/DWI offenders
Language Services
Spanish

Data Provided by:
Lowell Community Health Center Inc
(978) 937-9448
17 Warren Street
Lowell, MA
Services Provided
Substance abuse , Detoxification
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, Khmer, Portugese, Spanish

Data Provided by:
Team Coordinating Agency Inc
(978) 373-1181x10
66-76 Winter Street
Haverhill, MA
Services Provided
Substance abuse
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Persons with HIV/AIDS, Women, Men, DUI/DWI offenders, Criminal justice clients
Language Services
French, Spanish

Data Provided by:
Psychological Center
(978) 687-1658
582-584 Haverhill Street
Lawrence, MA
Services Provided
Substance abuse , Halfway house
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Women
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Silverman and Associates Inc
(603) 329-6440
2 Village Green Road
Hampstead, NH
Services Provided
Substance abuse , Detoxification
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Gays and Lesbians, Seniors/older adults, Men

Data Provided by:
Merrimack River Medical
(603) 595-3399
323 Derry Road
Hudson, NH
Services Provided
Substance abuse , Detoxification, Methadone Maintenance, Methadone Detoxification
Types of Care
Outpatient
Special Programs/Groups
Pregnant/postpartum women, Women, Men
Language Services
Spanish

Data Provided by:
Lowell House Inc
(978) 459-8656
555 Merrimack Street
Lowell, MA
Services Provided
Substance abuse
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, Men, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired, French, Khmer, Polish, 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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