Client Consent for Drug Testing and Disclosure of Results

Purpose

I, the undersigned client, hereby provide my consent for drug testing as part of my treatment at the above-mentioned facility. I understand that drug testing is conducted to monitor my progress, ensure my safety, and provide appropriate care for my co-occurring mental health (MH) and substance use disorder (SUD).

Consent

I understand that drug testing may involve the collection and analysis of urine samples for the presence of drugs and their metabolites. I consent to the collection, testing, and disclosure of my drug test results.

Disclosure of Results

I understand that my drug test results will be shared with the clinical team responsible for my care and treatment. I consent to the disclosure of my drug test results to authorized staff involved in my treatment, including healthcare providers, counselors, and administrative staff.

Confidentiality

I acknowledge that my drug test results will be treated with confidentiality and will only be disclosed to authorized staff on a need-to-know basis. I understand that my confidentiality will be maintained to the extent allowed by law and regulations governing healthcare privacy.

Right to Refuse

I understand that I have the right to refuse drug testing; however, I acknowledge that refusal may impact my treatment plan and participation in the program.

Duration of Consent

This consent for drug testing and disclosure of results is effective for the duration of my treatment at the facility unless revoked in writing by myself or as required by law.

Attestation

By signing below, I confirm that I have read and understood the information provided in this form. I voluntarily consent to drug testing and disclosure of my drug test results as described herein.