• If you are a health care provider serving or seeking health information from a person who has experienced domestic violence, sexual assault, or stalking, these frequently asked questions will help you:

    • Understand the safety and privacy concerns the person may have with sharing his/her health care information with another care provider.
    • Speak with the person about these concerns.
    • Identify the proper form for obtaining the person’s permission to share information about behavioral or mental health services, referrals and/or treatment for substance use disorders, or communicable diseases.
    • Identify referral resources for people who need information about and support for domestic violence, sexual assault, or stalking.

    To learn more about domestic violence prevention and services, visit www.michigan.gov/domesticviolence.
    To learn more about health information sharing, visit www.michigan.gov/bhconsent.

FAQ
Domestic Violence, Sexual Assault, and/or Stalking - Health Information Sharing for Professionals
When should health care providers use the standard consent form (DCH-3927) for release of specially-protected health information? When must a separate form be used?
Is there a standard separate form? What does a separate form look like?
Not all of the people I serve are receiving services for domestic violence, sexual assault, or stalking. Can I use the standard consent form (DCH-3927) for these individuals?
Why is a separate consent form needed to release specially-protected health information for individuals receiving services for domestic violence, sexual assault, or stalking?
What's the difference between the standard consent form developed by the Department under Public Act 129 of 2014 (DCH-3927) and the separate form I should use if I provided services for domestic violence, sexual assault, and/or stalking?
What should I do if I provided services for domestic violence, sexual assault, and/or stalking and the standard consent form (DCH-3927) isn't right for the person who received these services?
What should I do if I provided someone with services for domestic violence, sexual assault and/or stalking, and I receive a standard consent form (DCH-3927) from another provider that this person has signed?
What are referral resources for individuals who have experienced domestic violence, sexual assault, and/or stalking and need additional assistance?
What should I do if the person I am serving is in immediate danger?