Template: Consent for Uses and Disclosures of Part 2 Records

42 CFR Part 2 (“Part 2”) permits uses and disclosures of protected records with the prior written consent of the patient. This Template Consent provides a framework that Part 2 programs and others may adapt when creating consents authorizing uses and disclosures of Part 2-protected records.

This template reflects the 2024 Final Rule’s amendments to Section 2.31 of 42 CFR Part 2, which took effect on April 16, 2024 with a compliance date of February 16, 2026, as well as the HIPAA Privacy Rule’s requirements for authorizations in Section 164.508 of 45 CFR Part 164.

This template consent includes the required elements for a single consent for all future uses and disclosures for treatment, payment, and healthcare operations (TPO), as well as instructions for adapting the consent for disclosures to intermediaries (including health information exchanges, or HIEs), disclosures of SUD counseling notes, and disclosures for legal proceedings. 

This resource was authored by: Jacqueline Seitz, JD