State Health Information Guidance (SHIG) on Sharing Behavioral Health Information


The Office of Health Information Integrity has posted a revised version of the State Health Information Guidance (SHIG)


Effective February 2, 2018:  Due to the "Confidentiality of Substance Use Disorder Patient Records" (42 CFR Part 2) final rule published January 3, 2018, the required language documented in SHIG on pages 127 (Scenario 19), 135 (Scenario 21) and 152 (in Appendix 2) has been updated.  Each disclosure made with the patient's written consent must be accompanied with ONE of the following written statements:


"This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR part 2). The federal rules prohibit you from making any further disclosure of information in this record that identifies a patient as having or having had a substance use disorder either directly, by reference to publicly available information, or through verification of such identification by another person unless further disclosure is expressly permitted by the written consent of the individual whose information is being disclosed or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose (see § 2.31). The federal rules restrict any use of the information to investigate or prosecute with regard to a crime any patient with a substance use disorder, except as provided at §§ 2.12(c)(5) and 2.65"

- or -  


"42 CFR part 2 prohibits unauthorized disclosure of these records."

[Source: 42 CFR Part 2 Final Rule SAMHSA-4162-20, RIN 0930-ZA07 – "Confidentiality of Substance Use Disorder Patient Records"] 


The SHIG was published in June 2017. While the California Office of Health Information Integrity (CalOHII) received positive responses following its publication, we also received constructive feedback and observations from our readers regarding opportunities to improve the clarity and accuracy of the guidance.

As a result, CalOHII updated the SHIG to address this feedback and incorporate recent legislative changes. In addition, we undertook a thorough state legal review and analysis. Our goal was to improve the clarity and ease of use for the SHIG reader.

We are pleased to issue this updated SHIG, which reflects the following revisions:

  • Formatting for consistency across all sections to include standardized terms and citation references
  • Moving the "Navigating SHIG" section to the top of the document to assist readers
  • Updating all scenarios to provide greater clarity regarding state and federal regulations and statutes
  • Updating the "Summary Table of Key Laws" for ease of use
  • Adding information to "Appendix 2 – Patient Authorization for Use or Disclosure" to assist the reader in understanding the requirements for authorization forms

If you have a previous version of the SHIG, it should be discarded and replaced in full with this updated version. Note that this updated SHIG includes a date reference in the footer of all pages ensuring readers/users are referencing the most current version.

We strongly encourage all users of the SHIG to read this version in its entirety and, as always, to consult with your legal counsel if you have questions.



The California Office of Health Information Integrity (CalOHII), with support from the California Health Care Foundation, has created the State Health Information Guidance (SHIG). The SHIG is an authoritative but non-binding guidance from the State of California written in plain language for a general audience. It explains when, where, and why mental health and substance use disorder information can be exchanged and also provides clarification of state and federal laws.

The SHIG grew out of comprehensive research, drawing from a broad group of stakeholders that reflect cross-industry insights and experience, to get a clear understanding of the problems different groups were facing in the field. The result of the research is the SHIG, a guidance containing 22 scenarios derived from real user stories, which clarify how laws apply to actual situations that arise for care providers.

The SHIG is for YOU! The SHIG is applicable to Physical Health Care Providers, Mental Health Care Providers, Substance Use Disorder Providers, Emergency Service Providers, Caregivers and Care Coordinators, Social Services, Law Enforcement, and Payers.

On this website page, you can:

Download the SHIG 

  •  State Health Information Guidance (SHIG) (January 2018 version)
    This update reflects new required language (effective February 2, 2018) for re-disclosure of information due to the "Confidentiality of Substance Use Disorder Patient Records" (42 C.F.R. Part 2) final rule published January 3, 2018.


SHIG Webinar – July 25, 2017

Download Talking Points that contain content for speeches or presentations


View and download the SHIG One-Sheet, which is an outline for discussions, talks, and articles


Download the SHIG Introduction and Description, which can be used in organization newsletters and blogs

The purpose of providing these materials and resources is to encourage dissemination of the SHIG to those who can benefit most by understanding the Known Path to Yes.

For information about this project, please email