New Standard Consent Form to Improve Information Sharing, Quality Health Care

Contact: Jennifer Smith 517-241-2112

For Immediate Release: January 5, 2015

LANSING, Mich. – The Michigan Department of Community Health (MDCH) today announced the implementation of the new Behavioral Health Standard Consent Form (DCH-3927) aimed at improving the health information sharing process and the delivery of quality health care services for Michigan residents.

“As the health care community, it is important we look at new ways to integrate services and coordinate efforts to provide quality care for our residents,” said Nick Lyon, director of the MDCH. “By making the consent process easier to navigate, the new standard consent form will help streamline the health care delivery system for Michigan residents and the providers who care for them.”

Individuals and their health care providers share information with each other to diagnose health issues, make decisions about treatments, and coordinate care. Health care providers may also share 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.

On January 1, in accordance with Public Act 129 of 2014, MDCH released the standard consent form to make consent simpler for individuals and providers. In the past, providers developed their own forms to receive consent to share information. The differences between forms made sharing information across the health care system difficult for individuals and providers. The form will streamline information sharing for the following types of information:

  • Behavioral health or mental health services that are provided by or are under contract with the MDCH or a Community Mental Health Service Provider 
  • Referrals and /or treatment for a substance use disorder 
  • Communicable diseases such as sexually transmitted diseases and human immunodeficiency virus (HIV Infection, Acquired Immune Deficiency Syndrome or AIDS Related Complex).

Public Act 129 requires all public and private agencies, departments, organizations, and individuals involved with treatment of an individual experiencing serious mental illness, serious emotional disturbance, developmental disability, or substance use disorder to accept the standard form (DCH-3927) unless the entity is held to more stringent requirements under federal law.

For additional information about the Behavioral Health Standard Consent Form (DCH-3927), visit or contact the Department by phone at 844-275-6324 or by email at

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