Substance Abuse Templates

This form is used for applying to the Veterans Treatment Docket program in Virginia. The program aims to provide specialized treatment and support to veterans who are facing legal issues.

This form is used for individuals in Florida who have refused to submit to a breath and/or urine test during a DUI (Driving Under the Influence) arrest. It is an affidavit that acknowledges the refusal and can be used as evidence in legal proceedings.

This document is for the closure of a recovery house in Pennsylvania.

This form is used for notifying individuals in Wisconsin about the requirement for drug testing.

This form is used for obtaining prior authorization and submitting a substance abuse attachment in the state of Wisconsin.

This form is used for the Order on Petition for Determination of Eligibility for the Substance Abuse Program in the state of Wisconsin.

This Form is used for individuals in Wisconsin who want to apply for a determination of eligibility for the Substance Abuse Program under Section 302.05(3)(E) of the Wisconsin Statutes.

This form is used for recertifying the Community Substance Abuse Services (CSAS) Residential Intoxication Monitoring Service in Wisconsin.

This document is a contractor drug use statement that outlines the policy regarding drug use for contractors working on a project. It specifies the expectations and consequences related to drug use in the workplace.

This form is used for filing an appeal related to substance abuse prevention and control matters in Los Angeles County, California.

This document provides information about the contents of a Naloxone kit and the exchange procedure in Oakland County, Michigan. It is used to educate residents on how to properly use and exchange Naloxone, a medication used to reverse opioid overdoses.

This form is used for conducting a Level of Care Placement Assessment in Contra Costa County, California. It helps determine the appropriate level of care for individuals in need of support and services.

This form is used for applying for an ignition interlock credit in the state of Louisiana. It allows individuals to request a credit towards the cost of installing and maintaining an ignition interlock device in their vehicle.

This form is used for documenting direct observation of a Licensed Chemical Dependency Counselor Intern in Texas. It is used to assess the intern's competency and progress in their counseling skills.

This document is used in Alaska by supervisors to record observations and evidence of reasonable suspicion of workplace misconduct.

This type of document is utilized within the medical and mental health fields to measure an individual's craving and desire for a specific substance. It's largely used in addiction treatment for monitoring progress and assessing treatment effectiveness.

This document is a template that is used for creating a treatment plan for individuals who are seeking help for substance abuse. It outlines the goals, strategies, and interventions that will be utilized in the treatment process.

This form is used for obtaining prior authorization for opioid agents under Florida Medicaid in the state of Florida.

This form is used by licensed drug and alcohol facilities and recovery houses in Pennsylvania to request an exception to existing rules or regulations. Essential for treatment establishments seeking regulatory flexibility.

This document is used for documenting progress on substance abuse prevention and control in the County of Los Angeles, California. It follows a SOAP format for organized and comprehensive record keeping.

This document is utilized for initial evaluation of individuals seeking admission for Substance Use Disorder Treatment in Indiana health coverage programs. It is beneficial for understanding the patient's condition and treatment needs.

This document is used for recording progress notes in substance abuse prevention and control programs in Los Angeles County, California.

This document is used for outlining the terms and conditions between a healthcare provider and a patient regarding the treatment of controlled substances. It helps ensure safe and responsible medication use.