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Effective: 6/29/2026

G1.18 Informed Consent and Release of Information

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​Confidentiality requirements prohibit disclosure of protected health information (PHI) without obtaining informed consent and authorization for release of information from the individual or authorized representative.  Completion of the specified forms  gives the Department for Community Based Services (DCBS) consent to gather and share information on behalf of the client and family members. The information will be utilized to verify eligibility, make referrals, and provide benefits, services, or treatment to the client and family members.

Practice Guidance

  • The DCBS-1 and/or DCBS-1A remain in effect for the period designated from the date of signature unless:
    • The client revokes the consent in writing; or
    • DCBS services have ceased. 
  • If services to the client for a specific program close before the expiration date but other DCBS services are being provided, the form remains in effect for the other program areas that are continuing to provide services until the expiration of the consent. 
  • Upon expiration, the other DCBS program will be required to have the client complete a new form.​​

Procedure

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The SSW

  1. Completes the DCBS-1 Informed Consent and Release of Information and Records and/or DCBS-1A Informed Consent and Release of Information Records Supplement when registering the client for services, gathering and/or sharing information with an agency not initially designated for release, or when needing to add additional family members;
  2. Completes the DCBS-1 when requesting any information except for those regarding HIV/AIDS and substance abuse treatment; 
  3. Completes DCBS-1A when requesting information regarding HIV/AIDS and substance abuse treatment; 
  4. Legibly enters the name and Social Security number of the person signing the DCBS-1 and/or DCBS-1A;
  5. Lists the names of the specific agencies or individuals with whom DCBS may
    exchange information as authorized by the adult; 
  6. If additional agencies or individuals are identified, completes another DCBS-1 and/or DCBS-1A;
  7. Checks the specific items on the applicable form requested for release as they relate to services discussed in the assessment and case plan, and if "other" is checked, specifies the item to be released;
  8. Requires the individual providing consent to place a checkmark beside each item that applies;
  9. Under no circumstances completes or requests a client sign a blanket release for all services (all items checked) unless the assessment and case plan provide documentation of such need;
  10. Lists the name, Social Security number (SSN), and relationship provided by the adult for each member of the family for whom the individual has legal authority to consent;
  11. Allows for an adult to consent on behalf of children in the family, but if consent or information is needed on another adult in the home, that adult must also sign the DCBS-1 and/or DCBS-1A; 
  12. Complete an additional DCBS-1 and/or DCBS-1A if more than two (2) adult signatures are needed;
  13. Completes the duration of release to be:
    1. No more than ninety (90) days from the date of consent for a one (1) time release; or
    2. No more than twelve (12) months from the date of consent for ongoing cases;
  14. Requires signatures as follows: 
    1. The adult giving consent to the release signs the first signature line;
    2. An additional adult in the family consenting to release signs the second line,
    3. A witness signature is used as designated on the form when an adult uses an “X” as a signature;
  15. Signs the completed form;​
  16. Provides a copy of the signed, completed form to each adult signing the form;
  17. Files the original form in the case record;
  18. Completes another DCBS-1 and/or DCBS-1A, updates all relevant information, and obtains client consent, if services continue during the month of expiration of the DCBS-1 and/or DCBS-1A.
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Documents

Revisions