New Sample Consent Forms – 42 CFR Part 2

Consent Forms that Comply with Final Rule

August 1, 2017 – The Legal Action Center (LAC) has created several sample consent forms for the release of confidential substance use disorder patient records. The new forms comply with changes made to the federal regulations governing the confidentiality of substance use disorder patient records (known as “42 CFR Part 2” or simply “Part 2”) by a Final Rule issued in January 2017. The Final Rule took effect on March 21, 2017.

Under the revised regulations, consent form requirements vary based on the type of recipient. Therefore, LAC has created four basic consent forms for the release of substance use disorder information to:

  1. Individuals
  2. Entities that have treating provider relationships with the patient
  3. Third-party payers
  4. Entities that do not have treating provider relationships with the patient and are not third-party payers

LAC will soon issue a fifth sample basic consent form, for use with a “general designation” of recipients.

LAC’s book, Confidentiality and Communication, is currently being revised to reflect the changes to 42 CFR Part 2. The book will provide in-depth information about 42 CFR Part 2’s requirements, as well as additional sample forms and documents.

States, provider associations, and substance use disorder treatment providers may also subscribe to Actionline, LAC’s telephone hotline for questions about substance use disorder confidentiality and discrimination.

To receive updates about 42 CFR Part 2, including new materials released by LAC, please subscribe at:

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