CARES Consent Form 2026

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The document is an authorization form from the Alcohol and Drug Abuse Division (ADAD) allowing the disclosure of Protected Health Information (PHI) within the Coordinated Addiction Resource Entry System (CARES) for Substance Use Disorder (SUD) services. It outlines the individual's consent to share relevant health information for care coordination, treatment, and service provision, specifies the types of information that can be disclosed, and explains the rights of the individual regarding revocation of consent and confidentiality.

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Click ‘Get Form’ to open the CARES Consent Form in the editor.
Begin by filling in your personal information. Enter your first name, last name, address, and birth date in the designated fields.
Review the authorization section carefully. Check the box to authorize disclosure of your Protected Health Information (PHI) to agencies within the CARES provider network for care coordination and treatment purposes.
Specify which types of PHI you are authorizing for disclosure by selecting from the options provided, such as health information, billing details, or mental health records.
Initial where indicated to confirm your understanding and agreement with each section of the form.
Complete the purpose of disclosure section by confirming that it aligns with your needs for treatment and care coordination.
Sign and date the form at the bottom. If applicable, provide details about your personal representative's authority if someone else is signing on your behalf.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (70 Votes)

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What is a consent form for a caregiver?

A Caregiver Consent Form, prepared in advance, assures that the caregiver will be able to make medical decisions guided by health care professionals in your absence. You can create these forms without the need for a lawyer. Place prepared consent form copies next to emergency phone numbers.

What is a caregiver consent form?

Caregiver Consent Form. A Caregiver Consent Form, prepared in advance, assures that the caregiver will be able to make medical decisions guided by health care professionals in your absence.

What is an example of a consent form?

I have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. I understand that I will be given a copy of this consent form.

What letter do you need for a caregiver while parents are away?

A child care authorization letter is a legal document whereby parents give their written consent to a family member or non-relative to take temporary care of the child or children. This legal template enables non-parent caregivers to help children with any life situation they have.

What are the 4 types of consent forms?

Consent form 1 is for adults and those patients having anaesthetic Consent form 2 is for paediatrics Consent form 3 is for procedures without sedation Consent form 4 should be used when the patients lack capacity and should be completed by the professional doing the procedure.

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What is the consent form?

A document with important information about a medical procedure or treatment, a clinical trial, or genetic testing. It also includes information on possible risks and benefits. If a person chooses to take part in the treatment, procedure, trial, or testing, he or she signs the form to give official consent.

CARES Consent Form 2026

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