Substance Use Disorder Services – Forms
California Access to Recovery Effort (CARE)
Driving Under the Influence (DUI)
Drug Medi-Cal Treatment Program
Resource Center
Licensing and Certification (LCD)
Narcotic Treatment Program (NTP)
- Program List of Staff Function, Licenses, Hours and Dates of Hire/Termination (DHCS 5008)
- Employee Health Questionnaire (DHCS 5011)
- Initial Application (DHCS 5014)
- Licensing and Certification Division, Survey On-Site Review Process (DHCS 5015)
- Narcotic Treatment Program Licensing Branch, Licensing and Certification Division, Directory Change (DHCS 5016)
- Hospital Agreement (DHCS 5017)
- Buprenorphine Maintenance Services, Narcotic Treatment Program Licensing Branch, On-Site Inspection Worksheet, Patient Record Review (DHCS 5019)
- Guarantor Agreement (DHCS 5020)
- Two Plus Two State Exception (DHCS 5022)
- Consent For The Release of Confidential Information (DHCS 5024)
- Facility Requirements (DHCS 5025)
- State of California (DHCS 5026)
- County Recommendation (DHCS 5027)
- Letters of Cooperation (DHCS 5028)
- Buprenorphine Detoxification Services, Narcotic Treatment Program Licensing Branch, On-Site Inspection Worksheet, Patient Record Review (DHCS 5029)
- Geographical Area (DHCS 5030)
- Organizational Responsibility (DHCS 5031)
