Michigan Behavioral Health Standard Consent Form


Sharing individual health information is an important part of delivering quality health care.  Individuals and their health care providers share information with each other to diagnose health issues, make decisions on treatments, and coordinate care.

Health care providers may share many kinds of health information with other providers for the purposes of payment, treatment, and health care operations. However, providers must receive specific consent to share an individual’s health records containing certain types of information. In Michigan, federal and state laws require providers to receive consent to share information such as mental health records or information on treatment or referrals for alcohol and substance use.

On January 1, 2015, the Michigan Department of Health and Human Services (MDHHS) released a standard consent form for the sharing of health information specific to behavioral health and substance use treatment in accordance with Public Act 129 of 2014. In Michigan, while providers are not required to use this new standard form (MDHHS-5515), they are required to accept it.

If you are a resident looking for more information about the use of this form, please refer to the following Frequently Asked Questions document: MDHHS-Pub-1100, Frequently Asked Questions for Michigan Residents About the MDHHS-5515.

If you are a provider or organization looking for more information about the use of this form, please refer to the following Frequently Asked Questions document. MDHHS-Pub-1101 Frequently Asked Questions for Providers and Organizations About the MDHHS-5515 for more detail.

Behavioral Health Consent Form Handout
Behavioral Health Consent Form Background Information 
MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes 

While MDHHS is not able to provide legal advice, the Department can answer any other questions you may have by phone at 844-275-6324 or by email at MDHHS-BHConsent@michigan.gov.