Obtaining Consent for Treatment In obtaining the client's consent for treatment, gathering information from others about

his history of substance use, making referrals for continuing care, or seeking reimbursement from insurance carriers, hospital staff must be familiar with the provisions of special Federal and State laws and regulations for protection of clients' confidentiality as set forth in 42 U.S.C. 290dd-2 (1992) and C.F.R. Part 2. Intoxicated or psychotic clients may have diminished capacity for providing informed consent to treatment. If consent is obtained, even temporarily, from a relative, this may be considered a "disclosure of identifying information" and subject to Federal guidelines. In referring a client from a hospital to another treatment program and making an appointment, staff are also making a disclosure and will ordinarily need a written consent form from the client containing specified information (see Figure 5-9). Special exceptions, however, apply to information needed in a medical emergency that can be provided to medical personnel who need health- or treatment-related facts about a client in order to treat his life-threatening condition. However, the treatment program that is, for example, providing this information to a hospital before transferring the client for emergency care, must document specific data in his record regarding the nature of the emergency, what information was released, the name of the person making the disclosure, and the date and time. Additional information about consent, confidentiality, and other types of communications governed by Federal regulations is presented in TIP 19, Detoxification From Alcohol and Other Drugs, (CSAT, 1995d).