Starting in May 2013 paperwork and reports for all participants in the Peer Health Assistance Programs (PHAP) will be due on the 4^th of the month. 
When you submit your monthly paperwork on May 4^th, it will include the entire month of April (April 1-30).  

Submit Reports To:

 Click on the form name to print a copy of the form for your use.

Client General Information Sheet - Print & Fax - Updated 8/25/10

Consent forms have moved!  
To access the Consent forms Click Here.

Monthly/Quarterly Reports have moved! 
To access ELECTRONIC forms/reports, Click Here.
To access PAPER forms/reports, Click Here.

For Managers and Supervisors
Dental Prospective Employer and Supervisor Info Sheet - New April 2012 
Nursing Prospective Employer and Supervisor Info Sheet - New April 2012 
Pharmacy Prospective Employer and Supervisor Info Sheet - New April 2012

General Forms For All Clients
Contact Change Form - Updated 12/29/09
Insurance and Prescription Drug Information - Updated 11/2/10
Provider Verification Form - Updated 2/7/13
Relapse Prevention Plan - Updated 8/23/12
Relapse Prevention Plan - Advanced - Updated 8/23/12 
Relapse Prevention Plan—Mental Health - Updated 8/23/12
Talbott Medication Guide
Urine Screening Standards - Updated 10/5/10
Vacation/Travel Request  - Updated 11/21/12 NEW Travel Policy 
Medical Proceedure Time Off Request - NEW 10/17/11

General Forms For Nurses
Checklist for Employment - Updated 10/7/11
Client Handbook- Updated 6/2010 
Contract Change Request Procedure - Updated 11/2/10
FAQ - Updated 10/25/10

For Dentists
Client Handbook - Updated 11/09

For Pharmacists
Client Handbook - Updated 11/09