Completed reports can be faxed to:  720-213-1007   OR   720-213-0002

The following monthly/quarterly reports are standard pdf files.  Click on the form name and print a copy.  To utilize the new electronic forms, click here.

NOTE:  All Supervisory Reports were updated on 2/24/12.  Please make sure your Supervisor submits the most recent version.  There are separate Supervisor Reports for RN's and LPN's as well as for RN's in Non-Clinical Settings.  Students should be using the Clinical Preceptor Reports.  There are now four different Self Status Reports available.  Clients may choose one of the four to submit each reporting period.  It is the clients responsibility to maintain updated forms.  It is the clients responsibility to submit reports on the most updated version of the form.  Please make sure you are giving updated report forms to your providers as needed. 

To access Consent forms Click Here.

Monthly/Quarterly Forms For All Clients
Breathalyzer/Monitored Medication Report  - Updated 1150/08
Monthly Meeting List Report - Updated 1/20/11
Opiate Replacement Therapy Report - Updated 1/20/11
Pain Management Provider Report - Updated 1/20/11
Psychiatrist Report- Updated 1/20/11
Self Status Report- Updated 1/20/11
Self Status Report - Education Employment Report - Updated 1/20/11
Self Status Report - Monthly Recovery Plan - Updated 1/20/11
Self Status Report - Wellness Plan - Updated 1/20/11
Sponsor Report - Updated 1/20/11
Therapist Report - Updated 1/20/11
Therapist Report - Mental Health - NEW! 7/13/11
Treatment Provider Report - Updated 1/20/11

For Nurses
Supervisor Report for Registered Nurses - Updated 2/24/12
Supervisor Report for Licensed Practical Nurses - Updated 2/24/12
Supervisor Report for Registered Nurses in a Non-Clinical Setting - Updated 2/24/12
Nurse Practice Monitor Report - Updated 2/24/12
Nurse Student Clinical Preceptor Report - Updated 2/24/12 

For Dentists
Dentist Practice Monitor Report - Updated 3/28/12 
Dentist Resident Supervisor Report - Updated 2/24/12
Dental Student Preceptor Report - Updated 2/24/12
Dentist Supervisor Report - Updated 2/24/12

For Pharmacists
Pharmacist Supervisor Report  - Updated 2/24/12

For Fee For Service
Chiropractor Supervisor Report - Updated 2/24/12
Registered Dental Hygenist Supervisor Report - Updated 2/24/12
Mental Health Professional Supervisor Report - Updated 2/24/12
Respiratory Therapist Supervisor Report - Updated 2/24/12
Surgical Assistant Supervisor Report - Updated 2/24/12
Veterinarian Supervisor Report  - Updated 2/24/12