Resource Center: Consent forms

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Consent to Release of Information Under Title 42, Part 2, Code of Federal Regulations
Description: 
An example of the wording and structure necessary in a consent for release of information form.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Patient Handout: Confidentiality and Consent

Description: 
This is a patient handout to inform patients about their rights when undergoing office-based buprenorphine treatment.

Patient Rights: Confidentiality and Consent

As a patient getting treatment for a substance use disorder, your personal and medical

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Minors' Right to Consent to Health Care and to Make Other Important Decisions
Description: 
This series of tables provides state-by-state information about minors' rights regarding providing consent for substance abuse treatment.
Source: 
Guttmacher Institute
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Sample Consent Form

Description: 
This is a sample of a consent form that can be used when initiating buprenorphine treatment for a new patient.

BUPRENORPHINE MAINTENANCE TREATMENT

Sample #1 --Patient information and consent to treatment with buprenorphine

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Consent Form for Buprenorphine Treatment during Pregnancy
Description: 
This consent form informs the patient of the limited amount of research and knowledge currently available regarding buprenorphine use during pregnancy, and acknowledges that risks related to such use may exist, but are not yet known.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Sample Confidentiality and Consent Forms
Description: 
This appendix from TAP 13: Confidentiality of Patient Records for Alcohol and Other Drug Treatment provides sample consent forms for substance abuse patients.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Consent for Release of Information
Description: 
This form serves as a sample consent for release of the patient's information (type of information to be specified by the patient and/or doctor).
Source: 
American Academy of Addiction Psychiatry (AAAP)
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