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Downloadable forms you will need to participate in the program.

  • DPHMPAddendumToMonitoringAgreement
  • DPHMPAgreementToRefrainFromPractice
  • DPHMPConsentToReleaseUseAndExchangeInformation
  • DPHMPConsentToReleaseUseAndExchangeInformationForDPR
  • DPHMPConsenttoServicesEnrollmentAgreementBoardReferral
  • DPHMPConsentToServicesEnrollmentAgreementSelfReferral
  • DPHMPCreditCardAuthorization
  • DPHMPEmailConsent
  • DPHMPEnrollmentIntroductionLetterDelaware
  • DPHMPIntroductionLetterforToxicology
  • DPHMPLetterToLicenseeReferredByThirdParty
  • DPHMPMedicationManagementForm
  • DPHMPMedicationManagementGuidelineAndLetter
  • DPHMPMonitoringAgreementNewReferrals
  • DPHMPThirdPartyReferralForm

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.

  • DPHMPMedicationManagementGuidelineAndLetter
  • Guideline_MAT_DE_1.19.15
  • GuidelineForContactWithAgreementMonitor
  • GuidelineForDailyTestingNotification
  • GuidelineForDiluteAndLowCreatinineSpecimenResult
  • GuidelineForETGETSNonNegativeTestResult
  • GuidelineForManagementOfNonNegativeTestResults
  • GuidelineToxicologyExemptionDays
  • GuidelineToxTestingAndInclementWeather

Resources as well as important program information.

  • Delaware Over the Counter Medication Lists 2017
  • DPHMP_ProgramOverview_Flyer
  • DPMHP Approved Provider List
  • Over The Counter Meds List DPHMP
  • The Medication Guide for a Safe Recovery

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