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HI CARES Network Consent Form (Required for SUD Services) 2019-2025 free printable template

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Clear FormAlcohol and Drug Abuse Division (ADD) Authorization to Jointly Disclose Protected Health Information (PHI) Coordinated Addiction Resource Entry System (CARES) for Substance Use Disorder
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How to fill out HI CARES Network Consent Form (Required for SUD

01
Obtain the HI CARES Network Consent Form from your provider or online.
02
Read the form carefully to understand its purpose and implications.
03
Fill in your personal information, including your name, date of birth, and contact details.
04
Indicate your consent by checking the appropriate boxes as required.
05
Review the information you have provided for accuracy.
06
Sign and date the form at the designated area.
07
Submit the completed form to your healthcare provider or the appropriate agency.

Who needs HI CARES Network Consent Form (Required for SUD?

01
Individuals seeking substance use disorder (SUD) treatment.
02
Patients who wish to share their treatment information with healthcare providers within the HI CARES Network.
03
Individuals who are involved in programs that require consent for information sharing related to SUD.
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The HI CARES Network Consent Form is a document that allows individuals to provide consent for their substance use disorder (SUD) treatment information to be shared with authorized entities within the HI CARES network.
Individuals seeking treatment for substance use disorders, as well as their legal guardians if they are minors, are required to file the HI CARES Network Consent Form.
To fill out the HI CARES Network Consent Form, individuals must provide their personal details, specify the information they consent to share, and sign the document to authorize the release of their SUD treatment information.
The purpose of the HI CARES Network Consent Form is to ensure patient privacy while enabling the sharing of pertinent treatment information among health care providers to facilitate coordinated care and improve treatment outcomes.
The HI CARES Network Consent Form must report personal identifying information, the specific details about the SUD treatment, and the entities with whom the information can be shared.
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