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Elite Recovery

Diagnostic Assessment Declination Information Consent

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Under Minnesota Statutes §245G.15, clients have the right to make informed decisions regarding their treatment, including the right to decline specific services. Minnesota Statute under the 1115 waiver requires an individual receiving 245G SUD treatment to have a diagnostic assessment completed within 10 days of treatment initiation when the GAIN-SS mental health symptom screener is positive at intake. This form documents your decision to decline a mental health diagnostic assessment as part of your treatment at this facility.

Client Information

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Diagnostic Assessment Acknowledgement

Declining a Diagnostic Assessment Acknowledgement*
Please review and acknowledge your agreement with the following process and terms.
By signing below, I am authorizing the declination of a mental health diagnostic assessment at this time. I understand the potential implications of this decision on my treatment and acknowledge that I may request the assessment at a later date.
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Authorization to Reference Previous Diagnostic Assessment

Acknowledgment
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Client Testimonials

I just want to pass on to you guys that I’ve had a life changing experience at your facility. I was on edge about outpatient services and didn’t know how it would impact my life and never would have imagined it would have impacted my life the way it has. I’m very thankful for having the opportunity to be a part of Elite Recovery. Also, my counselor is the best counselor I’ve had in my recovery experience the last 2 years....

Samantha R.

Healthcare Professional

I wanted to take a minute to tell you both how EXTRAORDINARY my counselor is. She is compassionate, genuinely interested in the clients and ALWAYS brings a positive attitude to groups. I have worked in health care for MANY years and can spot an authentic person from a mile away. She handles difficult clients and situations with ease and ALWAYS leaves me feeling valued. She is a gem and TRULY appreciated!

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