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 (for purposes other than treatment, payment, and coordination of care) or information on treatment or referrals for alcohol and substance use disorder.

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.

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.

 

STANDARD CONSENT FORM

RELATED EDUCATIONAL DOCUMENTS ON THE STANDARD CONSENT FORM

 

SPECIFIC INFORMATION ON PRIVACY AND CONSENT CONSIDERATIONS FOR INDIVIDUALS WHO HAVE EXPERIENCED DOMESTIC VIOLENCE, SEXUAL ASSAULT, STALKING, OR OTHER CRIMES

Although sharing health information among providers has many benefits, it may also present safety risks for individuals who have experienced domestic violence, sexual assault, stalking, or other crimes. The following documents provide guidance for talking with individuals about the potential risks and benefits of information sharing and enabling them to make informed decisions about health information sharing.