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rule prohibiting disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31).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

Four County Counseling Center
(574) 722-5151
655 East Main Street
Peru, IN
Hotline
(800) 552-3106
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders
Language Services
ASL or other assistance for hearing impaired, Spanish

Data Provided by:
Otis R Bowen Ctr for Human Servs Inc
(260) 563-8446
255 North Miami Street
Wabash, IN
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Four County Counseling Center
(574) 722-5151x298
1015 Michigan Avenue
Logansport, IN
Hotline
(800) 552-3106
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, Women
Language Services
ASL or other assistance for hearing impaired, Spanish

Data Provided by:
Addiction and Family Care Inc
(219) 844-7152
3440 169th Street
Hammond, IN
Services Provided
Substance abuse
Types of Care
Outpatient
Special Programs/Groups
Adolescents, DUI/DWI offenders
Language Services
Spanish

Data Provided by:
Community Mental Health Center Inc
(812) 537-1302
285 Bielby Road
Lawrenceburg, IN
Hotline
(812) 537-1302
Services Provided
Substance abuse , Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents, Persons with co-occurring mental and substance abuse disorders, DUI/DWI offenders, Criminal justice clients
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Saint Joseph Hospital and Health Ctr
(765) 456-5900
1907 West Sycamore Street
Kokomo, IN
Hotline
(800) 638-7844
Services Provided
Substance abuse , Detoxification, Buprenorphine Services
Types of Care
Hospital inpatient, Outpatient, Partial hospitalization/day treatment
Special Programs/Groups
Adolescents
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Building Blocks In Education Inc
(765) 446-7900
1130 1/2 East Market Street
Logansport, IN
Services Provided
Substance abuse
Types of Care
Outpatient

Data Provided by:
Kokomo Living Life Clean LLC
(317) 695-8576
122 West Walnut Street
Kokomo, IN
Services Provided
Substance abuse , Detoxification
Types of Care
Outpatient
Special Programs/Groups
DUI/DWI offenders

Data Provided by:
Cummins Behavioral Health Systems Inc
(317) 272-3330
6655 East U.S. Highway 36
Avon, IN
Hotline
(888) 244-6083
Services Provided
Substance abuse
Types of Care
Outpatient, Partial hospitalization/day treatment
Language Services
ASL or other assistance for hearing impaired

Data Provided by:
Porter Starke Services Inc
(574) 772-4040
1003 Edgewood Drive
Knox, IN
Services Provided
Substance abuse , Buprenorphine Services
Types of Care
Outpatient
Special Programs/Groups
Adolescents

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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