Why do I need a separate form to share information about behavioral and mental health services, referrals and/or treatment for substance use disorders, or communicable diseases if I received services for domestic violence, sexual assault, or stalking?

If you have experienced domestic violence, sexual assault and/or stalking, it may be important to your safety to limit the sharing of your health care information. Use of a separate form allows you to tailor information sharing to your unique needs.

Additionally, the standard form developed by the Michigan Department of Community Health does not comply with the very strict privacy requirements that apply to agencies receiving certain types of federal grant funding to serve people who have experienced domestic violence, sexual assault or stalking.

Learn more about the Michigan Behavioral Health Standard Consent Form at www.michigan.gov/bhconsent.