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Other Resources
Downloadable forms you will need to participate in the program.
Abstinence Acknowledgement
Addendum To Monitoring Agreement
Agreement To Refrain From Practice
Consent To Release Use And Exchange Information For DPR
Consent To Release Use And Exchange Information
Consent To Services Enrollment Agreement Board Referral
Consent To Services Enrollment Agreement Self Referral
Credit Card Authorization
EmailConsent
Medication Management Form
Medtox Direct Mail Consent Form
Monitoring Agreement
Third Party Referral Form
Workplace Monitor Safe Practice Report
All policies governing the DPHMP are contained in the guidelines listed on this page. Enrolled licensees are held accountable to all guidelines. Updates will be posted as changes are made.
Guideline For Contact With Agreement Monitor
Guideline For Daily Testing Notification
Guideline For Dilute And Low Creatinine Specimen Result
Guideline For ETGETS NonNegative Test Result
Guideline For Management Of NonNegative Test Results
Guideline for Medication Assisted Treatment
Guideline Tox Testing And Inclement Weather
Guideline Toxicology Exemption Days
Medication Management Guideline And Letter
Resources as well as important program information.
Approved Evaluators and Treatment Facilities
Over The Counter Meds List
Program Intro - Enrollment Introduction Letter
Program Intro - Letter To Licensee Referred By Third Party
Program Intro - Program Overview Flyer
Program Intro - Toxicology Introduction Letter
