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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Psychiatric Associates
(920) 885-2780
200 Front Street
Beaver Dam, WI
Hotline
(920) 885-2780
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Family Resources Associates Inc
(920) 261-4100
1315 West Main Street
Watertown, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders

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:
Aro Counseling Centers Inc
(262) 367-5104
2314 North Grandview Bouldvard
Waukesha, WI
Services Provided
Substance abuse treatment
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders

Data Provided by:
L E Phillips Libertas Center
(715) 723-5585
2661 County Highway I
Chippewa Falls, WI
Hotline
(715) 723-5585
Services Provided
Substance abuse treatment, Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient
Special Programs/Groups
Adolescents
Language Services
ASL or other assistance for hearing impaired, Spanish

Data Provided by:
Dodge County Department of
(920) 386-3500
199 Home Road
Juneau, WI
Hotline
(920) 386-3500
Services Provided
Substance abuse treatment, Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders
Language Services
ASL or other assistance for hearing impaired

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:
Unified Community Services
(608) 935-2776
1122 Professional Drive
Dodgeville, WI
Hotline
(800) 362-5717
Services Provided
Substance abuse treatment
Types of Care
Outpatient

Data Provided by:
Triniteam Inc
(715) 836-8106
202 Graham Avenue
Eau Claire, WI
Services Provided
Substance abuse treatment
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:
Genesis Detoxification Center
(414) 342-6200
2835 North 32nd Street
Milwaukee, WI
Services Provided
Detoxification, Buprenorphine Services
Types of Care
Residential short-term treatment (30 days or less)
Language Services
ASL or other assistance for hearing impaired, 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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