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DWI Forms

Archived Forms

Forms and Clinical Records

• Authorization Process for DWI Services (5/13)
• Checklist of Documents for DWI-specific SA Assessments
• Client Contract (4/13)
• Client Rights and Grievances Policy (2/13)
• Client Information Transfer Sheet (PDF, 53KB)
• Discharge Summary
• DWI Services Authorization Fee (PDF) (4/13)
• Release of Information (7/12)
• Release of Information - Criminal Justice (7/12)
• Report of Facility Changes/Additions (5/12)
• Service Note
• Staff Resources
• Statement Prohibiting Re-disclosure for Inclusion in the Consent to Release of Information (7/12)
• Supervision Log I (1/10/12)
• Supervision Log II (1/10/12)
• Treatment Plan