42 CFR Part 2 Consent Builder

Substance use disorder records get their own consent, separate from an ordinary release. Fill this in to generate a consent that carries every element 42 CFR §2.31 requires, plus the prohibition-on-redisclosure notice. Nothing is stored or submitted — it builds in your browser and prints.

Fill in the details

Patient's full name Patient date of birth (optional, for identification) Part 2 program / entity disclosing the records Who the records go to (recipient name & role) What information may be disclosed Purpose of the disclosure Expires on (a date, or an event/condition) How the patient may revoke this consent

Fill in the fields and press “Build the consent.” The document appears here.

This is a template, not legal advice. The disclosing Part 2 program is responsible for the final form and for confirming it meets current 42 CFR Part 2 requirements (the 2024 final rule permits a single consent covering treatment, payment, and health-care operations). Have your compliance or legal team review before use. Mai Heaven is not the Part 2 program here.