Sample Consent: Health Information Exchange (Authorizing Disclosure of Confidential SUD Patient Records)

Developed in compliance with SAMHSA July 2020 final rule amending 42 CFR Part 2.

Graphic of electronic health information system

Sample patient consent form for release of SUD patient records to health information exchanges (HIE’s).

Please note that the CoE-PHI Team is currently working on an updated version of this resource that will reflect the 2024 final rule changes to 42 CFR Part 2.

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