Skip to content​​ 
Tsev Cov tib neeg Cov Kev Pab Kho Mob Tshuaj Yeeb​​ 

Cov Kev Kho Mob Narcotic​​ 

Kev Thov Kev Pab Cuam Narcotic Treatment Exception Request​​ 

The NTP Exception Request form is to facilitate the submission of patient exceptions to state regulations California Code of Regulations (CCR), Title 9, Chapter 4 in accordance with Section 10425This form is intended for exceptions that only require DHCS state approval and do not require SAMSHA’s federal approval.  This does not preclude other forms of notifications.  DHCS may grant a temporary exception request in accordance with CCR, Title 9, Section 10425 for individual licensed NTP locations on a per patient basis.​​ 

Patient exception requests to 42 CFR, Part 8, must be submitted through the CSAT portal as these are federal laws which require both DHCS and SAMHSA’S approval.​​   

All approved exception requests must be documented and maintained in the patient’s file.​​ 

DHCS 1834 NTP Exception Request Form to State Regulations Only​​ 

Daim Duab Qhia Txog Kev Thov Kev Zam NTP​​ 

Daim ntawv thov thiab cov ntawv​​ 

Daim Ntawv Thov RovUa Dua Daim Ntawv Tso Cai -
DHCS 4029 Ceeb
Toom Txog Kev Kho Mob Ib Ntus Rau Tus Neeg Mob - DHCS 4032 {cph0} Kev Pab Kho Mob Tshuaj Yeeb Daim
Ntawv Thov Thawj Zaug - DHCS 5014 Daim Ntawv Pom Zoo Los Ntawm Tus Neeg
Lav - DHCS 5020 Chaw
thiab Thaj Chaw Nyob - DHCS 5025 {cph0
Cov Ntaub Ntawv Rau Cov Neeg Ua Haujlwm - DHCS 5026 {cph0}
Daim Ntawv Pov Thawj Hauv Lub Nroog- DHCS 5027 Ntawv Qhia Txog
Kev Tuag Ntawm Tus Neeg Mob - DHCS 5048 Kev Lees Paub
Txog Kev KoomTes thiab Kev Koom Tes
- DHCS 5134Daim Ntawv Thov Kev Hloov Kho Cov Txheej Txheem - DHCS 5135​​ 

Xa txhua daim ntawv thiab cov ntaub ntawv txhawb nqa mus rau:​​ 

      Department of Health Care Services
      Counselor & Medication Assisted Treatment Section, MS2603
      PO BOX 997413
      Sacramento, CA 95899-7413​​ 

DHCSNTP@dhcs.ca.gov​​ 

Mobile Narcotic Treatment Programs​​ 

Kev Pabcuam Kev Kho Mob Narcotic Licensure Nqi​​ 

Lub Chaw Tso Cai Tso Cai thiab Ntawv Pov Thawj (LCD) tam sim no yuav lees txais kev them nyiaj online siv cov nyiaj hloov hluav taws xob ua tiav los ntawm Automated Clearing House (ACH) network. Cov kws kho mob tab tom nrhiav them cov nqi hluav taws xob tuaj yeem ua raws li cov lus qhia hauv qab no: https://www.govone.com/PAYCAL/DHCS/Account.​​ 

Cov lus nug nquag​​