This program will be collecting and disclosing the statistical information specified below to the Minnesota Department of Human Services (DHS) as required by Minnesota Statute 254A.03, subd. 1(d) and Title 42 Parts 2.52 and 2.53 of the Code of Federal Regulations.
The information includes age, race, sex, living arrangement, education, occupation, previous treatment, chemical use, legal status, and referral information and for publicly funded clients, Minnesota healthcare program placement information. None of the forms will have your name on them; a confidential code will be used.
This information will be used by DHS for internal research, program evaluation and auditing purposes only. Federal confidentiality regulations (42 C.F.R. Part 2) prohibit the disclosure of client data obtained in the course of these data collection efforts for purposes other than the original purposes for which it was intended. Unless otherwise allowed or required by law, no identifying information about you will be released without your express written authorization.
Federal confidentiality regulations (42 C.F.R. Part 2) prohibit the disclosure of client data obtained in the course of chemical dependency research for purposes other than the research for which it is intended.
If you have any questions about this notice you may contact DHS at (651) 431-2470.
You will be given a copy of this notice to keep.