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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Libertas of Sheboygan
(920) 803-0740
2108 Koehler Memorial Drive
Sheboygan, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Adolescents

Data Provided by:
Aurora Sheboygan Memorial Medical Ctr
(920) 451-5548
2629 North 7th Street
Sheboygan, WI
Hotline
(920) 451-5548
Services Provided
Substance abuse treatment, Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Maehnowesekiyah Wellness Center
(715) 799-3835
North 2150 Kesaehkahtek Street
Gresham, 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, Partial hospitalization/day treatment

Data Provided by:
Tellurian UCAN Inc
(608) 365-6600
74 Eclipse Center
Beloit, WI
Hotline
(608) 757-5025x0
Services Provided
Substance abuse treatment
Types of Care
Outpatient

Data Provided by:
Ho Chunk Nation Dept of Hlth/Soc Servs
(715) 284-9851x5010
6520 North Guy Road
Black River Falls, WI
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Women, Men, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired, Hochunk, Spanish

Data Provided by:
Sheboygan County Health & Human Serv
(920) 459-3151
1011 North 8th Street
Sheboygan, WI
Hotline
(920) 459-3151
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Women, Men
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Genesis Behavioral Services Inc
(920) 457-7802
503 Wisconsin Avenue
Sheboygan, 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
Persons with co-occurring mental and substance abuse disorders, Criminal justice clients

Data Provided by:
Koller Behavioral Health Services
(715) 369-2210
622 Mason Street
Rhinelander, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Gundersen Lutheran
(608) 269-1588
218 West Main Street
Sparta, WI
Hotline
(608) 775-4344
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
ARC Community Services Inc
(608) 283-6430
202 North Patterson Street
Madison, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Women, 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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