Sample Consent: Authorizing Disclosure of Confidential SUD Patient Records

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

Sample patient consent form for release of SUD Patient records developed by the CoE-PHI.

Resource available in English and Spanish.

Sample Consent: Authorizing Disclosure of Confidential SUD Patient Records (PDF 316.28 KB)
Modelo de Consentimiento: Autorizando la Divulgacion de Registros Medicos Confidenciales Sobre el Trastorno de Uso de Sustancias (SUD) (PDF 365.61 KB)
Topics
Format
  • PDF

Type

Law

Author

  • CoE-PHI

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