Consent: Rules about Obtaining Consent to Disclose Treatment Information South Bend IN

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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

YWCA of Saint Joseph County
(574) 233-9491
1102 South Fellows Street
South Bend, IN
Hotline
(866) 937-9922
Services Provided
Substance abuse
Types of Care
Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days), Outpatient
Special Programs/Groups
Women, Residential beds for clients' children

Data Provided by:
Life Treatment Centers Inc
(574) 233-5433x218
1402 South Michigan Street
South Bend, IN
Services Provided
Substance abuse , Detoxification, 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
Pregnant/postpartum women, Women

Data Provided by:
Crossroads Counseling
(574) 233-4183
2319 Edison Road
South Bend, IN
Services Provided
Substance abuse
Types of Care
Outpatient

Data Provided by:
Victory Clinic Services II
(574) 233-1524
4005 Western Avenue
South Bend, IN
Services Provided
Substance abuse , Detoxification, Methadone Maintenance, Methadone Detoxification
Types of Care
Outpatient
Language Services
ASL or other assistance for hearing impaired, French, Spanish

Data Provided by:
Addiction Recovery Centers Inc
(574) 807-8690
2012 Ironwood Circle
South Bend, IN
Services Provided
Substance abuse
Types of Care
Outpatient

Data Provided by:
Madison Center Inc
(574) 280-4655
801 East Washington Street
South Bend, IN
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Gays and Lesbians
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Madison Center Inc
(574) 282-8712
813 South Michigan Street
South Bend, IN
Services Provided
Substance abuse
Types of Care
Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Women, Men

Data Provided by:
Dockside Services Inc
(574) 299-8595
2625 South Michigan Street
South Bend, IN
Hotline
(574) 299-8595
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Addictions Recovery Centers Inc
(574) 807-8690
2012 Ironwood Circle
South Bend, IN
Services Provided
Substance abuse
Types of Care
Outpatient

Data Provided by:
Wellspring Counseling and Learning Ctr
(574) 784-2700
207 South Michigan Street
Lakeville, IN
Services Provided
Substance abuse
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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