The Common Consent Form was created to allow individuals to
sign a single consent form for sharing information across multiple agencies (as
opposed to signing a separate form for each agency). When submitting a
referral, a consent form is not required to be completed by the NWD effort.
However, each agency needs to decide if they will:
- Accept this form and not require a separate consent form to be completed if it has been filled out by another agency.
- Adopt the Common Consent Form as an approved form for their staff to use.
The one-page Common Consent Form, which has been reviewed
and approved by the DOH and DHS deputy attorney generals, collects the
following information:
- Participant/representative identifying information
- Identification of agencies and information the consent applies to, including identification of information not to be shared with identified agencies
- Reason and mechanism for sharing the information
- Participant rights and responsibilities
- Participant/representative signature
A copy of the form can be found at:
