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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

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