Consent: Rules about Obtaining Consent to Disclose Treatment Information Mountain View CA

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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Community Health Awareness Council
(650) 965-2020x13
711 Church Street
Mountain View, CA
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Gays and Lesbians, Criminal justice clients
Language Services
Arabic, Chinese, French, German, Spanish

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Adolescent Counseling Services
(650) 329-9410
445 Sherman Avenue
Palo Alto, CA
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Criminal justice clients

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Williams House 1and 2
(650) 462-4602
1085 Weeks Street
East Palo Alto, CA
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Criminal justice clients

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Kaiser Permanente Medical Group
(408) 366-4200
19000 East Homestead Road
Cupertino, CA
Services Provided
Substance abuse , Detoxification
Types of Care
Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Men
Language Services
Spanish

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Catholic Charities of Santa Clara Cnty
(408) 468-0100
2625 Zanker Road
San Jose, CA
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Women, Men

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North County
(650) 328-1441
231 Grant Avenue
Palo Alto, CA
Services Provided
Substance abuse
Types of Care
Outpatient
Language Services
Spanish, Vietnamese

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Free at Last
(650) 462-6999x4602
1095 Weeks Street
East Palo Alto, CA
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days)

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Daytop Village Inc
(650) 325-6466x15
2560 Pulgas Avenue
Palo Alto, CA
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days), Outpatient
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders, Persons with HIV/AIDS, Women, Men

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Recovery Connections Trt Servs LLC
(408) 249-9927
807 Park Court
Santa Clara, CA
Services Provided
Substance abuse
Types of Care
Residential long-term treatment (more than 30 days)
Special Programs/Groups
Persons with co-occurring mental and substance abuse disorders

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VA Palo Alto Healthcare System
(650) 617-2734x22734
795 Willow Road
Menlo Park, CA
Hotline
(866) 717-1978
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
Persons with co-occurring mental and substance abuse disorders

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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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