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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

MARCO Services Inc
(920) 684-0605
1114 South 11th Street
Manitowoc, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential long-term treatment (more than 30 days)
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Koinonia Residential Treatment Center
(800) 864-3009x2100
1991 Winnebago Street
Rhinelander, WI
Hotline
(888) 299-1188
Services Provided
Substance abuse treatment, Detoxification
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, Pregnant/postpartum women, Women, Men, Criminal justice clients

Data Provided by:
North Central Healthcare Facilities
(715) 848-4600
1100 Lakeview Drive
Wausau, WI
Hotline
(800) 799-0122
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
HDC
(715) 392-8216
39 North 25th Street East
Superior, WI
Hotline
(715) 395-2259
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Women, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

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:
Kewaunee County Dept of Human Services
(920) 388-7030x270
810 Lincoln Street
Kewaunee, WI
Hotline
(920) 388-7030
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Cottonwood Group Homes Ltd
(715) 268-7997
773 Rustic Road
Amery, WI
Services Provided
Substance abuse treatment
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders

Data Provided by:
Genesis House
(262) 544-0711
1002 Motor Avenue
Waukesha, WI
Services Provided
Substance abuse treatment, Halfway house
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Men

Data Provided by:
Bellin Psychiatric Center
(920) 431-5533
301 East Saint Joseph Street
Green Bay, WI
Services Provided
Substance abuse treatment, Detoxification
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Door County Department of
(920) 746-2345
421 Nebraska Street
Sturgeon Bay, WI
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

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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