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  • Consent/authorization To Release Substance Abuse Assessment And/or Treatment Information

Get Consent/authorization To Release Substance Abuse Assessment And/or Treatment Information

ACY-1125A FORNA (2-10) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Division of Children, Youth and Families CONSENT/AUTHORIZATION TO RELEASE SUBSTANCE ABUSE ASSESSMENT AND/OR TREATMENT INFORMATION NOTICE.

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42 CFR part 2 • No one can use any program info to: – Initiate or substantiate criminal charges against a patient, or – Conduct a criminal investigation of patient. unless have qualifying court order. Cannot place undercover agents or informants in program.

Information may be disclosed only under a unique court order meeting requirements of 42 CFR Part 2. A subpoena is not sufficient. Both the court order and a subpoena must be issued to compel disclosure.

HIPAA allows care providers to make disclosures when working with other healthcare professionals to coordinate treatment; 42 CFR Part 2 does not. Law enforcement cannot access treatment records covered by 42 CFR Part 2 without a special court order that depends on the satisfaction of higher standards.

There are a few limited exceptions when providers can make disclosures without a patient's written consent, including: Internal communications. Medical emergencies. Reports of alleged child abuse or neglect (if required by state law)

Part 2 requires each disclosure made with written patient consent to be accompanied by a written statement that the information disclosed is protected by federal law and that the recipient cannot make any further disclosure of it unless permitted by the regulations (42 CFR § 2.32).

Purpose of Disclosure: You may use this space to provide the reason you are requesting the records. On the Transfer ROI: Please include the reason you are requesting to transfer s that this information can be provided to the new agency. ROI's can be used for extended release for up to a year, if there are no changes.

The regulations at 42 CFR part 2 (“Part 2”) protect the confidentiality of substance use disorder (SUD) treatment records.

Part 2 requires each disclosure made with written patient consent to be accompanied by a written statement that the information disclosed is protected by federal law and that the recipient cannot make any further disclosure of it unless permitted by the regulations (42 CFR § 2.32).

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232