Consent: Rules about Obtaining Consent to Disclose Treatment Information Vicksburg MS

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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Warren/Yazoo Chemical Dependency Ctr
(601) 634-0181
3442 Wisconsin Avenue
Vicksburg, MS
Services Provided
Substance abuse , Detoxification
Types of Care
Residential short-term treatment (30 days or less), Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders

Data Provided by:
Warren/Yazoo Mental Health Service
(601) 638-0031
3444 Wisconsin Avenue
Vicksburg, MS
Hotline
(601) 638-0031
Services Provided
Substance abuse
Types of Care
Residential short-term treatment (30 days or less), Outpatient
Special Programs/Groups
DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Life Help
(662) 887-5441
200 East Baker Street
Indianola, MS
Hotline
(662) 453-6211
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
New Life for Women Inc
(601) 355-2195
814 North Congress Street
Jackson, MS
Services Provided
Substance abuse , Halfway house
Types of Care
Residential short-term treatment (30 days or less), Residential long-term treatment (more than 30 days)
Special Programs/Groups
Women

Data Provided by:
Marian Hill Chemical Dependency Center
(601) 883-3532
100 McAuley Drive
Vicksburg, MS
Services Provided
Substance abuse , Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, Men
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Delta Community Action Association
(318) 574-4164
404 East Craig Street
Tallulah, LA
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Baptist Behavioral Health Services
(601) 968-1102
800 Carlisle Street
Jackson, MS
Hotline
(800) 962-6868
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
ASL or other assistance for hearing impaired

Data Provided by:
Pine Belt Mental Healthcare Resources
(601) 544-4641
103 South 19th Avenue
Hattiesburg, MS
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders

Data Provided by:
Region 8 Mental Health Services
(601) 591-5553
613 Marquette Road
Brandon, MS
Hotline
(601) 825-8800
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders

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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